Practices and predictors of menstrual hygiene management material use among adolescent and young women in rural Pakistan: A cross- sectional assessment

Background In low-and middle-income countries (LMICs), women often use inappropriate materials to manage menstruation, which can threaten their health. Improper practices can also have critical downstream consequences beyond physiologic health, including restricting adolescent girls' access to ac-ademic pursuits. Methods We used cross-sectional data collected through a structured question-naire from the menstruating adolescents and young women 15-23 years of age living in rural Pakistan (n = 25 305). We aimed to describe menstrual hygiene management (MHM) practices and generate a predictive model of the socioeco-nomic and demographic factors related to the use of MHM materials. Beliefs and barriers around MHM were also summarized. The outcome variable included: those who practiced appropriate and inappropriate MHM practices. Logistic re-gression was used to generate the predictive model, with results presented as odds ratios (OR) and 95% confidence interval (CI). Results Inappropriate MHM practices were reported by 75% (n = 19 006) of participants. The majority 61.9% (n = 15 667) reported using old cloths, 12.6% (n = 3191) used nothing, and 0.5% (n = 136) used old cloth with a sanitary pad. One-fourth of participants reported appropriate MHM material use, including 16.2% (n = 4087) sanitary pads, 8.6% (n = 2167) new cloth, and a few reported using sanitary pads with new cloth 0.2% (n = 45). Inappropriate MHM practic-es were more common in lowest wealth quintile (OR = 4.41; 95% CI = 2.77-7.01, P < 0.0001), followed by those with no education (OR = 3.9; 95% CI = 3.36-4.52, P <0.0001). Conclusions The study indicates the need for multi-sectoral efforts to intro-duce MHM-specific and MHM-sensitive interventions to improve MHM prac-tices, ranging from the availability of low-cost MHM materials to the inclusion of MHM education in school curriculums and within the community platforms.