Drivers of Hygienic Menstrual Practices among Reproductive-Age Women: Evidence from Nepal Demographic Health Survey-2022

Background: Exclusive use of hygienic methods during menstruation has not received adequate attention in Nepal, with limited research utilizing nationally representative data. Therefore, this study explored the prevalence and factors influencing exclusive hygienic menstrual practices among women of reproductive age in Nepal. Methods: This study included 13,066 reproductive-age women from the Nepal Demographic and Health Survey (NDHS-2022). A binary logistic regression model was applied to identify significant factors of exclusive use of hygienic methods among women in Nepal. To quantify the proportion of the total variance attributable to differences between communities. The concentration Index (CI) and Concentration curve (CC) were also calculated to measure the socio-economic inequality of exclusive use of hygienic methods among reproductive agewomen. Results: Only 48% of Nepalese women aged 15- 49 years used exclusively hygienic methods to prevent bloodstains during menstruation. The results of the multivariate model revealed that young women aged 15-24 (AOR=2.51, p<0.001), women with 10 years and above education (AOR=1.98, p<0.001) from the richest wealth quintile (AOR=2.16, p<0.001), never married women (AOR=1.44, p<0.001), owned a smartphone (AOR=1.41, p<0.001) and women with exposure to mass media at least once a week (AOR=1.36, p<0.001) are more likely to use hygienic methods as compared with their counterparts. The results from the concentration curve also demonstrated that exclusive use of hygiene methods among women is concentrated in women from higher economic backgrounds (CI: 0.21). Among the geographical regions of Nepal, the highest inequality was witnessed in Madhesh province (CI: 0.25), followed by Bagmati province (CI: 0.22). Conclusions: The findings suggest the need for multidimensional interventions and educational programs targeting socioeconomically vulnerable women to address unhygienic menstrual practices. Also, there is a need to educate adult women on biological facts and good hygienic practices, as they can impose cultural taboos and restrictions on the next generation.