Geographical disparity and socio-demographic correlates of menstrual absorbent use in India: A cross-sectional study of girls aged 15-24 years

Objectives: The study has twofold objectives: (1) to study the geographical differences in uptake and use of menstrual absorbents among girls aged 15-24 years in India; and (2) to identify the socio-demographic factors associated with usage of different types of menstrual absorbents. Study design: The study uses information from a nationally representative sample of 247,833 girls of 15-24 years collected in the fourth round of the National Family Health Survey (2015-2016) based on a multi-stage clustered random sampling design. Methods: The study used two-step statistical analyses: (1) bivariate and GIS-based mapping tools were used to show geographical and socio-economic variation in the use of menstrual absorbents; (2) Multinomial Logistic Regression (MLR) and Multiple Classification Analysis (MCA) models were used to identify the factors associated with usage of different type of menstrual absorbents among Indian girls. Results: The results point to a substantial state-wide variation in the use of menstrual absorbents across India ranging from the highest in Mizoram (93.4%) to the lowest in Bihar (31%). District level variations are more striking. Adjusted percentages from the MLR model show that more girls in the southern Indian states, northeastern states, and union territories tend to exclusively use Sanitary Napkins and Tampons (hereafter SNTs) compared to the states in the northwest, central, and eastern regions of India. Besides, girls with a higher level of education (35.2%, p < 0.01), belonging to the richest wealth quintile (64.7%, p < 0.01), and those who have full exposure to mass media (43.9%, p < 0.01) use SNTs more than their counterparts. Conclusions: Given that education and economic status are significant hurdles, the policy has to focus on: first, disseminating knowledge on menstrual protection via dialogue and discussions at various levels, starting from school to communities to mass media campaigns. Second, the state has to take the responsibility to ensure universal access to menstrual absorbents regardless of geographic location and economic standing of the adolescent girls. Ensuring menstrual absorbents at public places (schools and workplaces) and tax cuts can make them accessible and affordable to all.