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Background <p>In Afghanistan, little is known about menstrual hygiene management (MHM) and the social isolation women experience during menstruation. Drawing on the nationally representative 2022–23 Afghanistan Multiple Indicator Cluster Survey (MICS), we quantified the prevalence of appropriate MHM and menstrual-related social exclusion and examined their sociodemographic drivers.</p> Methods <p>We conducted a cross-sectional analysis of 40,330 women aged 15–49 years who responded to questions on MHM, corresponding to those who had menstruated in the past year preceding the survey. “Appropriate MHM” was defined as the use of a sanitary pad, tampon, or clean cloth, plus access to a private space for changing or washing. “Social exclusion” captured any missed social activities, work, or schooling due to menstruation. Survey-weighted logistic regression models estimated adjusted odds ratios (AORs) for both outcomes, including interaction and stratified analyses by place of residence.</p> Results <p>Overall, 86.0% of women met criteria for appropriate MHM, yet 30.2% reported menstrual-related social exclusion. Provincial estimates of appropriate MHM varied widely (49.4% in Jawzjan to 98.5% in Khost), and social exclusion ranged from 2.7% (Ghor) to 79.0% (Faryab). After adjustment, women in rural areas (AOR: 1.91, 95%CI: 1.53–2.37), those with internet access (AOR: 1.50; 1.19–1.90), and those from the richest wealth quintile (AOR: 1.66; 1.22–2.26) had significantly higher odds of appropriate MHM. Never-married women had lower odds of appropriate MHM (AOR 0.86; 0.75–0.97). The odds of social exclusion were lower in women aged 18–24 (AOR: 0.87; 0.78–0.96), 25–34 (AOR: 0.79; 0.70–0.89), and 35–49 (AOR: 0.86; 0.76–0.98). However, mobile-phone ownership was associated with higher odds of social exclusion (AOR: 1.20; 1.08–1.33). A significant interaction by residence (<i>p</i> &lt; 0.001) indicated that lack of adequate MHM was associated with higher odds of social exclusion among urban women (AOR: 1.46; 1.07–2.00), whereas in rural areas it was associated with lower odds (AOR: 0.68; 0.56–0.82).</p> Conclusion <p>Although the majority of Afghan women report appropriate MHM, nearly one-third still experience social exclusion during menstruation. Policy efforts should prioritize low-tech, community-based approaches to address menstrual health challenges, particularly among unmarried and economically disadvantaged women, while considering digital platforms as complementary tools for subgroups with existing access.</p>

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Menstrual hygiene management and social exclusion among women in Afghanistan: insights from a national survey

  • 期刊论文

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  • 发表日期：

    2026年5月11日

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  • Omid Dadras,
  • Muhammad Haroon Stanikzai,
  • Zainab Ezadi,
  • Massoma Jafari,
  • Fateme Dadras,
  • Essa Tawfiq

摘要

Background

In Afghanistan, little is known about menstrual hygiene management (MHM) and the social isolation women experience during menstruation. Drawing on the nationally representative 2022–23 Afghanistan Multiple Indicator Cluster Survey (MICS), we quantified the prevalence of appropriate MHM and menstrual-related social exclusion and examined their sociodemographic drivers.

Methods

We conducted a cross-sectional analysis of 40,330 women aged 15–49 years who responded to questions on MHM, corresponding to those who had menstruated in the past year preceding the survey. “Appropriate MHM” was defined as the use of a sanitary pad, tampon, or clean cloth, plus access to a private space for changing or washing. “Social exclusion” captured any missed social activities, work, or schooling due to menstruation. Survey-weighted logistic regression models estimated adjusted odds ratios (AORs) for both outcomes, including interaction and stratified analyses by place of residence.

Results

Overall, 86.0% of women met criteria for appropriate MHM, yet 30.2% reported menstrual-related social exclusion. Provincial estimates of appropriate MHM varied widely (49.4% in Jawzjan to 98.5% in Khost), and social exclusion ranged from 2.7% (Ghor) to 79.0% (Faryab). After adjustment, women in rural areas (AOR: 1.91, 95%CI: 1.53–2.37), those with internet access (AOR: 1.50; 1.19–1.90), and those from the richest wealth quintile (AOR: 1.66; 1.22–2.26) had significantly higher odds of appropriate MHM. Never-married women had lower odds of appropriate MHM (AOR 0.86; 0.75–0.97). The odds of social exclusion were lower in women aged 18–24 (AOR: 0.87; 0.78–0.96), 25–34 (AOR: 0.79; 0.70–0.89), and 35–49 (AOR: 0.86; 0.76–0.98). However, mobile-phone ownership was associated with higher odds of social exclusion (AOR: 1.20; 1.08–1.33). A significant interaction by residence (p < 0.001) indicated that lack of adequate MHM was associated with higher odds of social exclusion among urban women (AOR: 1.46; 1.07–2.00), whereas in rural areas it was associated with lower odds (AOR: 0.68; 0.56–0.82).

Conclusion

Although the majority of Afghan women report appropriate MHM, nearly one-third still experience social exclusion during menstruation. Policy efforts should prioritize low-tech, community-based approaches to address menstrual health challenges, particularly among unmarried and economically disadvantaged women, while considering digital platforms as complementary tools for subgroups with existing access.