Determinants and spatial patterns of hygienic menstrual practices among tribal Women in India

Abstract

Menstrual hygiene management (MHM) is a critical yet neglected component of women’s reproductive health in India, particularly among tribal populations who face compounded socio-economic, cultural, and geographic disadvantages. Despite improvements in hygienic menstrual practices at the national level, tribal women continue to lag behind, and evidence on spatial and socio-economic heterogeneity within this group remains limited. This study uses data from the National Family Health Survey-5 (NFHS-5, 2019–21) to examine the prevalence, spatial distribution, and determinants of exclusive hygienic menstrual practices among 44,392 tribal women aged 15–24 years in India. Exclusive hygienic practice was defined as the use of sanitary napkins, locally prepared napkins, tampons, or menstrual cups without concurrent use of unhygienic methods. Descriptive statistics, district-level spatial mapping, and multivariable logistic regression analyses were used to examine the determinants and spatial distribution of exclusive hygienic menstrual practices. Only 65.4% of young tribal women exclusively used hygienic menstrual methods, with substantial variation across states and districts. Higher education and household wealth were strongly associated with greater odds of hygienic practice, while rural residence and increasing age reduced the likelihood. The availability of improved toilet facilities was positively associated with hygienic menstrual use. Significant regional disparities were observed, with lower odds in central India and higher odds in southern and western regions. District-level maps suggested substantial intra-state variation in exclusive hygienic menstrual practices. Persistent socio-economic and spatial inequalities continue to shape menstrual hygiene practices among tribal women in India. Interventions must move beyond uniform national strategies and adopt region- and district-specific approaches that integrate education, poverty alleviation, reproductive health awareness, and improved access to affordable menstrual products to advance menstrual equity among tribal populations.