Socioeconomic inequalities and its spatial pattern in sanitary napkin use in Bangladesh: evidence from the 2019 multiple indicator cluster survey.

BACKGROUND

Utilization of unhygienic menstrual products has been associated with various adverse health consequences, particularly in many low- and middle-income countries (LMICs), including Bangladesh. In this context, this study attempted to measure socioeconomic inequalities in sanitary napkin use among women aged 15-49 and assess its spatial pattern at the disaggregated level (district).

METHODS

We used the latest available nationally representative cross-sectional Bangladesh Multiple Indicator Cluster Survey (MICS) 2019 data. The analytical sample size was 54,702 reproductive-aged (15-49 years) women. The Erreygers Index (EI) and the Wagstaff Index (WI) were employed to measure and decompose the socioeconomic inequalities in sanitary napkin use. Natural Break (Jenks) classification method, Global Moran's I and the Cluster and Outlier Analysis were used to analyze the spatial pattern of socioeconomic inequalities at the district level.

RESULTS

The findings reveal that approximately 26.22% of women used sanitary napkins at the national level. Both the EI (0.41208; p-value < 0.001) and the WI (0.53251; p-value < 0.001) indicate a pro-rich inequality in sanitary napkin use. Decomposition results indicated that wealth status, educational attainment, household characteristics (particularly educational attainment of household head) and exposure to media were the most important factors accounting for socioeconomic inequalities. From the spatial analyses, we found significant district-level variations in both sanitary napkin use and its socioeconomic inequalities. Global Moran's I value indicated positive spatial autocorrelation, meaning that similar values tend to cluster together. Notably, a northwestern and southeastern divide was found between High-High and Low-Low clusters of socioeconomic inequalities.

CONCLUSIONS

Our study provides evidence for informed policymaking targeting women from the lower socioeconomic stratum, especially those living in the northwestern and southeastern regions to increase sanitary napkin use.