A Geographical Analysis of Access to Adequate Menstrual Health and Hygiene Resources Among Young Women in India

Achieving a safe and dignified menstruation experience necessitates not only access to menstrual products but also to water, sanitation, hygiene, and privacy. In this study, we, therefore, define access to adequate menstrual health and hygiene (MHH) resources as inclusive of water, sanitation, hygiene, privacy, and hygienic menstrual products. Our objective is to explore spatial variations in access to adequate MHH resources among young women across districts in India, with a focus on identifying potential clustering patterns. Additionally, we aim to examine the factors associated with access to these resources at the district level.

We analysed data from 191,152 women aged 15–24 obtained from the fifth round of National Family Health Survey (2019–2021). Spatial analysis techniques, including choropleth maps, Global Moran’s I, and Anselin’s Local Moran’s I, were employed to analyse spatial patterns, measure spatial autocorrelation, and identify clusters and outliers in access to adequate MHH resources, respectively. Additionally, spatial regression analysis was conducted to examine the factors associated with access to adequate MHH resources at the district level.

Only 21.8% of young women in India had access to adequate MHH resources. There were considerable disparities at the district level, with access ranging from as low as 0.6% in Kulgam, Jammu and Kashmir, to as high as 82.2% in Sherchhip, Mizoram. Cluster and outlier analysis identified several hot-spots (districts with higher access to adequate MHH resources surrounded by similarly higher values) of higher access to adequate MHH resources, including districts in the northern states, parts of Uttarakhand, Kerala, and Mizoram. Conversely, cold-spots (districts with low access to adequate MHH resources surrounded by similarly low values) were found in northern Madhya Pradesh, western Odisha, northeastern Karnataka, central West Bengal, as well as northern and southern Bihar, Uttar Pradesh, and northern Chhattisgarh. Additionally, the analysis revealed that a higher proportion of non-SC/ST (β = 0.063, p < 0.001), non-poor (β = 0.277, p < 0.001), and urban populations (β = 0.141, p < 0.001) were positively associated with better access to MHH resources at the district level in India.

The substantial geographic disparities in access to adequate MHH resources among young women in India underscore the urgent need for targeted interventions for underserved areas. There is also a critical need to integrate MHH and WASH initiatives at both the policy and implementation levels in India.