# Exploring the temporal shift in menstrual hygiene practices among young women across India: a micro and macro perspectives

## TL;DR

This study examines how menstrual hygiene practices among young Indian women improved from 2016 to 2021, highlighting the role of awareness, education, and socio-economic factors.

## Contribution

The study uniquely combines micro and macro perspectives to analyze spatial and temporal shifts in menstrual hygiene practices using NFHS data.

## Key findings

- Menstrual hygiene practices increased by 20% points between 2016 and 2021, especially in marginalized groups.
- Geospatial attributes, awareness, education, and economic factors significantly influence menstrual hygiene practices.
- Media exposure and women's education are the top contributors to improved menstrual hygiene practices.

## Abstract

Lack of menstrual hygiene practices (MHP) is one of the primary causes of reproductive morbidities among young women. The recent National Family Health Survey (NFHS) showed a significant increase in the use of hygienic menstrual methods in India. This paper aims to investigate the spatial and temporal changes in the prevalence of hygienic menstrual practices from 2016 to 2021, considering micro and macro perspectives.

The study is based on women aged 15–24. The Datasets used in this study are from two recent rounds of the National Family Health Survey, NFHS-4 and NFHS-5. Descriptive, bivariate, multilevel, spatial, and Fairlie decomposition methods have been used to analyze spatial and temporal changes in MHP.

The study illustrates that the prevalence of MHP has increased by 20% points over the past five years, with a significant rise in the use of sanitary napkins, even among marginalized groups. Spatial variation and temporal changes reveal the influence of geospatial attributes, awareness, education, sanitation, and economic prosperity on MHP. Multilevel analysis portrays the maximum clustering in the MHP at the household level in both survey years. Further, Fairlie decomposition reveals that media exposure, followed by the educational attainment of women, contributes highest to the increase in MHP from NFHS-4 to NFHS-5.

The findings of the study present a significant amount of influence of geospatial attributes, including culture and tradition. The extent of “awareness” regarding menstrual hygiene emerged as the most critical driver of escalating MHP in the country. Therefore, addressing socio-economic disparities and implementing interventions through community-level programs, preferably by adopting peer-based approaches with the active participation of self-help groups and frontline workers, is necessary to ensure universal access to sanitary methods.