Menstrual hygiene management practices among rural females: Findings from a Rural Health Demographic Environmental Surveillance System (HDESS) cohort in Odisha, Eastern India

Swetalina Nayak¹Mamata Nayak¹Soumya Nayak¹Debasini Parida¹Bijaya Kumar Mishra¹Abhinav Sinha¹Sanghamitra Pati¹Gayathri Delanerolle²Peter Phiri²Ashish Shetty²Sohier Elneil²Biswabara Rout³Subrata Kumar Palo^1*

• ¹Regional Medical Research Center (ICMR), Bhubaneswar, India
• ²Southern Health NHS Foundation Trust, Southampton, United Kingdom
• ³SCB Medical College and Hospital, Cuttack, Odisha, India

Introduction: Menstrual hygiene management is an important public health component to promote reproductive health, especially in rural areas of low-and middle-income countries (LMICs). Present study assessed the menstrual hygiene practices, the disposal methods and associated health effects among school students, college students, and community women in rural setting of a Health Demographic Environmental Surveillance System (HDESS) in Odisha, India. Methods: A crosssectional survey was carried out in March-May 2023 using three cohorts of participants, namely school students, college students, and community women aged between 14-49 years and currently experiencing cycles of menstruation. The study used a multi-stage random sampling method with a descriptive analysis comparing patterns of sanitary pad use, its disposal practice and complications linked to the use of pads. Continuous variables such as age and cost incurred on menstrual products were reported using mean and standard deviation. The chi-squared value was used to determine possible associations and affirm the statistical significance, p-value (<0.05). Results: Among 622 participants, 541 (86.9%) reported using sanitary pads. Cloth users rated their experience as "excellent" (48.7%), while dissatisfaction was highest among government-provided pad users (29.7%). Self-procured pad users reported the highest "manageable" experience (44.9%). The most common method of disposing the sanitary materials was by burying (40.2%). Approximately 68.32% of participants reported menstruation related health issues whilst 23.9% reported sanitary pad-related issues. About 16.8% of the participants reported of menstrual irregularities, school students being the most (44.8%). Discussion: The use of disposable sanitary pads appear to be the most common menstrual hygiene management practice in rural areas. Awareness, shame, and costs could be barriers to accessing sanitary pads along with poor environmental impact when disposing of these using improper methods. Reform the policy by introducing awareness of overall health implications linked to menstrual hygiene and access to low-cost menstrual management products could promote reproductive health. Also, government partnerships with NGOs to implement village-level menstrual waste management systems, subsidies for eco-friendly pad production, and mandatory disposal education in school health programs could mitigate the problem.