Hasan Emran, Chakma Salit, Khanam Moriam, Hajizadeh Mohammad
School of Health Administration, Dalhousie University, Halifax, NS, Canada.
Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Mississippi, USA.
Popul Health Metr. 2025 Jul 9;23(1):37. doi: 10.1186/s12963-025-00401-0.
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).
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.
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.
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.
使用不卫生的经期用品会带来各种不良健康后果，在包括孟加拉国在内的许多低收入和中等收入国家（LMICs）尤其如此。在此背景下，本研究试图衡量15至49岁女性在使用卫生巾方面的社会经济不平等，并在细分层面（地区）评估其空间格局。
我们使用了最新可得的具有全国代表性的2019年孟加拉国多指标类集调查（MICS）横断面数据。分析样本量为54702名育龄（15至49岁）女性。采用埃雷格斯指数（EI）和瓦格斯塔夫指数（WI）来衡量和分解使用卫生巾方面的社会经济不平等。运用自然断点（詹克斯）分类法、全局莫兰指数I以及聚类与离群值分析来分析地区层面社会经济不平等的空间格局。
研究结果显示，在国家层面，约26.22%的女性使用卫生巾。EI（0.41208；p值<0.001）和WI（0.53251；p值<0.001）均表明在使用卫生巾方面存在有利于富人的不平等现象。分解结果表明，财富状况、教育程度、家庭特征（特别是户主的教育程度）以及接触媒体是造成社会经济不平等的最重要因素。从空间分析来看，我们发现卫生巾使用情况及其社会经济不平等在地区层面存在显著差异。全局莫兰指数I值表明存在正空间自相关，即相似的值往往聚集在一起。值得注意的是，在社会经济不平等的高高聚类和低低聚类之间发现了西北和东南的差异。
我们的研究为针对社会经济地位较低阶层的女性，特别是居住在西北和东南地区的女性制定明智的政策以增加卫生巾使用提供了证据。
