Department of Geography, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
GIRL Center, Population Council, NY, USA.
Int J Equity Health. 2023 Sep 29;22(1):202. doi: 10.1186/s12939-023-02020-3.
The use of hygienic products, such as sanitary napkins, tampons, and menstrual cups, to absorb menstrual blood is vital for the health and well-being of adolescent girls in India. However, the degree of inequity in the use of such products among this subpopulation remains inadequately explored. To fill this critical knowledge gap, this study aims to investigate the spatiotemporal dynamics of hygienic product use among adolescent girls in India from 2015 to 2020.
In this cross-sectional study, we analyzed data from 117,749 to 114,839 adolescent girls aged 15-19, obtained from two consecutive rounds of the National Family Health Survey (NFHS) conducted in India during 2015-16 and 2019-21. Our approach involved utilizing Erreygers' Concentration Index (ECI) and Concentration Curve to quantitatively assess and visually represent socioeconomic inequality in hygienic product usage. Additionally, we investigated the spatiotemporal variation in this inequality over the study period and decomposed the ECI to identify the key contributing factors.
The findings reveal that hygienic product usage among adolescent girls in India has increased by 13 percentage points (PP), from 37% in 2015-16 to 50% in 2019-21. This increase is also visible across all household wealth quintiles. However, the bottom quintiles experienced a greater rise (+ 15 to 16 PP) than the top quintile (+ 8 PP). During the study period, the ECI reduced marginally, from 0.48 in 2015-16 to 0.43 in 2019-21. However, the extent of this reduction varied across different states. The greatest reduction in ECI was recorded in Punjab (-0.23 points), Telangana (-0.16 points), and West Bengal (-0.14 points). In contrast, there were a number of states with high socioeconomic inequality (ECI > 0.30) in 2015-16, where inequality reduction was minimal (< 0.05 points) over the study period. This included more developed states of Kerala, Karnataka, Maharashtra and Gujarat and relatively less developed states of Odisha, Jharkhand, Chhattisgarh, Uttar Pradesh, and Assam. Some states, such as Bihar and Madhya Pradesh, recorded an increase in socioeconomic inequality over the study period, with ECI rising to 0.31 and 0.46 (highest in the country) in 2019-21. The decomposition analysis revealed that the inequality in using hygienic products was primarily explained by place of residence, exposure to mass-media, education, and region of residence.
The findings suggest the need for targeted policies to reduce existing socioeconomic inequality in the usage of hygienic products among adolescent girls in India. Specifically, interventions should target regions with low use of hygienic products, economically disadvantaged groups, and poor and vulnerable populations. State-specific policies and programs are also necessary to address the disparities in socioeconomic inequality. Additionally, efforts to reduce inequality should address the underlying factors contributing to inequality.
在印度，卫生棉条、卫生巾和月经杯等卫生产品对于少女的健康和福祉至关重要。然而，在该亚群中，这些产品的使用存在很大的不平等程度，这一问题尚未得到充分探索。为了填补这一关键知识空白，本研究旨在调查 2015 年至 2020 年期间印度少女使用卫生产品的时空动态。
在这项横断面研究中，我们分析了来自两轮印度国家家庭健康调查（NFHS）的数据，调查对象为 15-19 岁的少女，调查时间分别为 2015-16 年和 2019-21 年。我们采用 Erreygers 集中指数（ECI）和集中曲线，对卫生产品使用方面的社会经济不平等情况进行定量评估和直观呈现。此外，我们还研究了研究期间该不平等程度的时空变化，并对 ECI 进行了分解，以确定关键的促成因素。
研究结果显示，印度少女使用卫生产品的比例增加了 13 个百分点（PP），从 2015-16 年的 37%增加到 2019-21 年的 50%。所有家庭财富五分位数都呈现出这一增长。然而，底层五分位数（+15 至 16PP）的增长幅度大于顶层五分位数（+8PP）。在研究期间，ECI 略有下降，从 2015-16 年的 0.48 下降到 2019-21 年的 0.43。然而，这种下降程度在不同的州之间存在差异。ECI 下降幅度最大的是旁遮普邦（-0.23 点）、特伦甘纳邦（-0.16 点）和西孟加拉邦（-0.14 点）。相比之下，在 2015-16 年，有许多州存在高度的社会经济不平等（ECI＞0.30），这些州在研究期间的不平等程度减少很小（＜0.05 点）。其中包括更发达的喀拉拉邦、卡纳塔克邦、马哈拉施特拉邦和古吉拉特邦，以及相对欠发达的奥里萨邦、恰蒂斯加尔邦、恰尔康得邦、北方邦和阿萨姆邦。一些州，如比哈尔邦和中央邦，在研究期间报告了社会经济不平等程度的增加，ECI 分别上升至 0.31 和 0.46（全国最高）。分解分析显示，卫生产品使用不平等主要由居住地点、大众媒体接触度、教育程度和居住地区决定。
研究结果表明，印度需要采取有针对性的政策来减少少女使用卫生产品方面现有的社会经济不平等。具体而言，干预措施应针对卫生产品使用率低的地区、经济上处于不利地位的群体以及贫困和弱势群体。还需要制定针对特定州的政策和计划，以解决社会经济不平等的差异。此外，减少不平等的努力应解决导致不平等的根本因素。
