Unmet Need, Practice, Perception and Predictors of Menstrual cup Use among Medical and Paramedical Students and Staffs: A Cross-Sectional Study from Eastern India

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Venkata Rao, Binod Kumar Patro, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5683546/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Menstrual cups are a cost-effective, sustainable, and safe alternative to other menstrual products. However, they are less popular or not widely used, such as sanitary pads. The study aimed to estimate the unmet need, prevalence and associated factors of menstrual cup use. Methods The study was conducted in a tertiary medical college in Odisha, eastern India. All female medical and paramedical students and staff aged 18–45 years were included in the study. Women with surgical/physiological menopause and those denied consent to participate in the study were excluded. Unmet need was defined as females willing to use menstrual cups but not using them currently. Bivariate and multivariate logistic regression models were used to find the factors associated with menstrual cup use. Model 1 analysed individual characteristics (age, marital status, participant's education, and knowledge related to menstrual cups). Model 2 added family factors (mother's education, type of family, and family income and in final model 3 incorporated social/environmental factors (residence and caste). Results Out of 538 participants, 339 intend to use the menstrual cup; however, only 15 participants use the menstrual cup currently. The unmet need was 95.58% [95% CI 92.81%-97.50%]. The prevalence of menstrual cup use is 2.79% [95% CI 1.57%-4.56%]. Women who rated their knowledge of menstrual cups as good were likelier to adopt menstrual cups as menstrual hygiene management than those with poor/average knowledge [OR 10.81 (95% CI 3.04–38.49)]. Mother’s education was significant in bivariate analysis [OR 4.17 (95% CI 1.09–15.95)]; however, it was not significant in model 3. The reasons for unmet needs were comfortable with sanitary napkins, no adequate knowledge about menstrual cups, the requirement of support during menstrual cup use, fear of insertion, lack of privacy, fear of being struck inside the vagina, and social taboos. Conclusion Despite the benefits, menstrual cup use remains low while unmet needs are high. A strong association exists between individuals with good knowledge of menstrual cups and their likelihood of using them. To address this, public health initiatives are necessary to enhance knowledge and provide support, promoting menstrual cups as a sustainable solution for menstrual hygiene management among women of reproductive age. Unmet Need Menstrual Cup India Figures Figure 1 Figure 2 Figure 3 Background Menstruation is a natural biological process experienced by approximately 1.8 billion individuals worldwide every month. ( 1 , 2 ) Over the past decade, menstrual health has emerged as a significant public health challenge with growing recognition of the need for affordable and effective menstrual products. However, the most widely available options, such as disposable sanitary pads and tampons, contain high levels of plastic and pose significant environmental challenges. ( 3 ) In developing countries like India, the improper disposal of sanitary pads remains a significant concern; when disposed of in open fields or landfills, these products not only become breeding grounds for harmful microbes but also contribute to long-lasting environmental pollution, as the plastic content in sanitary napkins takes centuries to decompose. ( 3 , 4 ) The menstrual cup (MC) is a bell-shaped device, typically composed of medical-grade silicone, designed to be inserted into the vagina to collect menstrual fluid during menstruation. It can be worn for up to 6–8 hours, depending on the volume of menstrual flow. Featuring the capacity to be washed and reused for ten years ( 5 – 7 ), the menstrual cup presents the benefits of cost-effectiveness, reusability, and environmental friendliness. ( 7 , 8 ) Menstrual cup use is more acceptable as it eliminates unpleasant odour and sogginess and is worn internally. ( 9 ) Research indicates that menstrual cups are highly accepted by women, who prefer them to traditional products because of their cost-effectiveness and convenience. ( 10 ) Studies further suggest that menstrual cups are a safe choice for managing menstruation, as they do not negatively impact vaginal flora and pose no health risk. ( 9 , 11 ) By providing a reliable and cost-effective option for menstrual hygiene, menstrual cups can effectively meet the needs of women, thus promoting enhanced menstrual health and hygiene overall. ( 11 ) Community awareness regarding the benefits and use of menstrual cups needs to be improved in India. Despite growing global recognition of the advantages of menstrual cups, their adoption in India is predominantly limited to a small, highly educated group of professional women. ( 6 , 12 , 13 ) Even among educated women, including healthcare workers and providers, the usage of menstrual cups is minimal. ( 11 ) As the uptake of menstrual cups is multifactorial and multidimensional, it is critical to understand the cascade of knowledge, their intent to use, and unmet needs regarding its adoption in their routine life/current practice. ( 12 ) The challenges and associated factors for the uptake of menstrual cups will provide more insights into its local adoption. They can guide further pathway action to improve reproductive health and empower women. ( 5 , 8 , 12 ) This study aims to assess the burden of unmet needs related to menstrual cup use, explore the reasons behind these gaps, estimate the prevalence of MC adoption, and identify the key factors associated with its uptake. By addressing these issues, the study seeks to inform future actions that can support more widespread and sustainable adoption of menstrual cups in India, ultimately contributing to better reproductive health outcomes. Methods A cross-sectional study was conducted at a leading tertiary medical college of Odisha, India. Students mostly from eastern India pursue their undergraduate education. The participants included female medical and paramedical students and paramedical staff aged between 18 to 45 years. All females in the specified age range and occupation were included. Exclusions were made for women who had undergone surgical or physiological menopause and those who did not consent to participate. The sample size was calculated based on the unmet need for menstrual cup of 65% ( 8 ) with an absolute precision of 5%, a design effect of 1.5 to account for the sampling method, and a non-response rate of 10%. The estimated sample size was 578 participants. Simple random sampling was employed to select the participants from the sampling frame. The sampling frame comprised of all female medical and paramedical students and staff aged 18 to 45 in SOA, Bhubaneswar. Unmet need was defined as females who expressed willingness to use menstrual cups if available but were currently not using them. Menstrual cup use was considered when the female has been using a menstrual cup for the last three or more months. Out of 1766 eligible participants, 578 were selected by simple random sampling. After essential administrative approval, the selected participants were approached at college or home. The participants were provided with an information sheet, and the purpose of the study was explained in detail. After obtaining written informed consent, data were collected using semi-structured questionnaires. The questionnaire included sections on individual characteristics (age, marital status, participant's education, knowledge related to menstrual cups), family factors (mother's education, type of family, family income), and social/environmental factors (residence, caste). Data were initially recorded using Epicollect5, a mobile data collection application that facilitated the systematic entry of participant responses. Once the data collection phase was completed, the collected data were exported from Epicollect5 into Excel for preliminary organisation and cleaning. Subsequently, the cleaned data were imported into Statistical Package for the Social Science ( SPSS) version 27.0 for detailed statistical analysis. Bivariate and multivariate logistic regression models were used to analyse the data. Three models were constructed: Model 1 Included individual characteristics (age, marital status, participant's education, and knowledge of menstrual cups). Model 2: Added family factors (mother's education, type of family, family income) and variables in Model 1. Model 3: incorporated social and environmental factors (residence, caste) and the variables in Model 2. The regression models were used to identify factors associated with menstrual cup use among the study participants. The study received approval from the institute ethics committee (SOA, Bhubaneswar) wide ref no./IEC/IMS.SH/SOA/2022/427 dated 14th October 2022. Confidentiality and anonymity of the participants' data were strictly maintained throughout the study. Results Out of 578 participants, 40 were excluded; finally, 538 were interviewed and included in the analysis (Figure 1). The mean (SD) age of participants was 23 ± 4.2 years. The mean age at menarche was 13±1.3 years. Most participants (80.3%) were between 18-25 years, while 19.7% were aged 26 years or older. Among participants, 46.3% were nursing staff, 25.6% were MBBS students, 27.5% were nursing students, and 0.6% were pharmacists. Majority participants (88.7%) were unmarried. Around half of the participants (54.6%) lived in urban areas and 13.9% in semi-urban areas.Regarding family structure, 68.4% of participants belonged to nuclear families, while 31.6% were from joint families. As for religion, 95.5% of the participants identified as Hindu, 3.5% as Christian, 0.6% as Muslim, and 0.4% as other religions. Two participants identified as tribal without specifying any particular religion. Caste-wise, 59.1% of participants belonged to the general category, 25.5% to OBC, 10.8% to SC, and 4.6% to ST. Approximately two-thirds of participants (68.4%) lived in a nuclear family. Regarding maternal education, 13.7% of the participants’ mothers held professional degrees or honours, 30.9% were graduates, 11.9% had intermediate or diploma qualifications, 26.2% completed high school, 8.2% finished middle school, 4.6% had primary schooling, and 4.5% were illiterate. Concerning the occupation of the family heads, 38.7% were professionals, 33% were semi-skilled workers, 20% were skilled workers, 11.3% were unskilled workers, and 4% were either unemployed or retired (Table 1). Family income varied, with 15.1% earning up to INR 27,882 per month, 23.4% between INR 27,883 – 46,474, 19.5% between INR 46,475 – 69,534, 11.7% between INR 69,535 – 92,950, 11.7% earning between INR 92,951 – 1,85,894, and 18.2% earning INR 1,85,895 or more.(Table 1) Out of 538 participants, 517 (96.1%) participants reported that they were using sanitary pads as the current menstrual hygiene management (MHM) practice, followed by menstrual cups (n=15, 2.78%), tampons (n=4, 0.75%) and cloth pads (n=2, 0.37%) (Table 2). Menstrual cup was seen by 433 (80.48%) participants and, 126 (23.6%) participants rated their knowledge of menstrual cups as good, 218 (40.5%) as average, and 193 (35.9%) as poor (Figures 2 and 3). Of the 538 participants, 339 intend to use the menstrual cup; however, only 15 participants currently use the menstrual cup. The burden of unmet need was 95.58% [95% CI 92.81%-97.50%]. The prevalence of menstrual cup use was 2.79% [95% CI 1.57%-4.56%]. (Table 3) The primary reasons for the unmet need for menstrual cups were participants' comfort with sanitary napkins (82.4%, 267 participants) and insufficient knowledge about menstrual cups (53.7%, 174 participants). Additionally, 5.2% (17 participants) expressed the need for support in using the cup effectively, while fear of insertion was a concern for 4.9% (16 participants). A lack of privacy at home or in the workplace was reported as a barrier by 4.3% (14 participants). Other concerns included fear of the cup becoming stuck inside the vagina (1.9%), social taboos surrounding its use (1.5%), and difficulties with sterilisation (1.2%). (Table 4) In the bivariate analysis, knowledge about menstrual cups [OR 9.65 (95% CI 3.02–30.87)] and mother’s education [OR 4.17 (95% CI 1.09–15.95)] were found to be associated with menstrual cup use. However, in model 3, after adjusting for individual, family, and social factors, women who rated their knowledge of menstrual cups as good were significantly more likely to adopt menstrual cups for menstrual hygiene management compared to those with poor or average knowledge [aOR 10.81 (95% CI 3.04–38.49)], while mother’s education became non-significant [aOR 1.93 (95% CI 0.26–14.07)]. (Table 5) Age, education of participants, marital status, type of family [aOR 0.43 (95% CI 0.09-2.09)], family income, caste and residence [aOR 0.47 (95% CI 0.11-2.07)] were not associated with menstrual cup use among study participants. (Table 5) Discussion The findings of this study shed light on the current landscape of menstrual cup adoption in eastern India. The prevalence of menstrual cup use among the study population was notably low, at 2.78%. However, the NFHS-5 survey, (2019-21) has reported only 0.3% of females aged 15 to 24 have used menstrual cups. Though the prevalence of menstrual cups was low, it was higher than the national estimate of NFHS, which can be attributed to the difference in the study population. ( 14 ) This discrepancy may also be due to the regional variations in menstrual cup adoption, which differences could influence awareness, socioeconomic factors, cultural norms, and access to menstrual health products across different parts of the country. ( 6 , 12 , 15 ) Similarly, the unmet need was 95.6%, indicating a significant disparity between intention and actual usage of menstrual cups, with only a small fraction of participants currently using them despite a substantial expressed interest. This highlights an apparent discrepancy between awareness and adoption, suggesting that various barriers prevented their actual uptake. A study from South India reported a higher prevalence of menstrual cup use at 6%. However, a significant majority, 80% of the study participants, were aware of the menstrual cup, and 65% said they would use it if it were available.( 8 ) The differences in findings between this study and the South Indian study could be attributed to regional variations and contextual factors despite similarities in the study populations. These variations highlight the need for targeted interventions to address local barriers and enhance the adoption of menstrual cups in different regions of India. A key determinant influencing the adoption of menstrual cups is the level of knowledge about these products. Participants rated their knowledge as good and were over ten times more likely to adopt menstrual cups for hygiene management than those with poor or average expertise. This highlights the crucial role of educational and awareness campaigns in promoting menstrual cups as a viable alternative to traditional menstrual products. Interestingly, while maternal education initially appeared to be a significant factor in the bivariate analysis, this association diminished when adjusted for other individual, family, and social factors in the multivariate model. This suggests that although maternal education may initially impact attitudes toward menstrual health practices, broader socio-environmental factors play a more substantial role in shaping actual behaviour regarding menstrual cup adoption. Most participants preferred sanitary napkins, possibly due to their limited exposure to menstrual cups and a lack of direct comparative experience. Participants’ feedback on the high unmet need for menstrual cups reveals several barriers to their uptake, including inadequate knowledge, lack of support during initial use, fear of insertion, privacy concerns, myths regarding vaginal obstruction, and prevailing societal taboos related to menstruation. Including the above reasons during the MHM interventions is essential, as it could enhance acceptance and increase menstrual cup adoption among women. Studies also found menstrual cups pose no health hazards to females. It doesn’t cause bacterial or yeast infection on prolonged use since it is made of nonreactive medical-grade silicon. ( 9 , 11 ) Most women feel comfortable switching to menstrual cups thoroughly after their second or third use. ( 3 , 16 ) Education and awareness are pivotal in introducing and popularising menstrual cups among women in India. ( 8 , 16 ) Due to limited exposure, many women may not be familiar with menstrual cups or lack a comprehensive understanding of how to use them effectively. By offering education on the anatomy of the female reproductive system along with a focus on menstrual cups, misconceptions and myths surrounding their usage can be addressed. ( 16 ) Support and guidance are essential for women who are new to using menstrual cups, particularly during the initial stages of adoption. ( 3 , 16 ) Offering comprehensive information on inserting and removing the cup and addressing common concerns such as leaks and discomfort can significantly enhance women's confidence in using menstrual cups effectively. ( 3 ) Providing ongoing support through various channels ensures that women have the assistance they need to overcome any challenges they may encounter. By offering handholding support and fostering a supportive environment, we can empower women to embrace menstrual cups as a sustainable and comfortable menstrual hygiene option for the long term. ( 11 ) The study's limitation is that the study's results can't be generalised to all the reproductive age group population as the study was conducted among a specific population like medical and paramedical students and staff. Conclusions Despite the proven benefits of menstrual cups, their usage remains low, and unmet need is high. A strong link exists between having good knowledge of menstrual cups and the likelihood of using them. However, limited awareness of menstrual cups, the need for support during initial use and myths and social barriers related to menstrual cups are critical barriers to adoption. To address this, targeted public health efforts are essential. These should focus on increasing knowledge, providing clear guidance, and supporting new users. Promoting menstrual cups as a sustainable and practical option can help meet the growing demand for effective menstrual hygiene management among women of reproductive age. Abbreviations aOR adjusted Odd Ratio CI Confidence Interval INR Indian Rupee MBBS Bachelor of Medicine and Bachelor of Surgery MHM Menstrual Hygiene Management NFHS National Family Health Survey OBC Other Backward Classes OR Odd Ratio SC Scheduled Caste ST Scheduled Tribe SOA Siksha ‘O’ Anusandhan Declarations Ethics approval and consent to participate: The study received approval from the institute ethics committee (SOA, Bhubaneswar) wide ref no./IEC/IMS.SH/SOA/2022/427 dated 14 th October 2022. The study adhered to the standard guidelines of the Declaration of Helsinki. Written informed consent was obtained from study participants before data collection. Consent for publication: Not applicable Acknowledgements: None Authors Contribution: Conceptualisation-SMB, PB, EVR, BKP & SK Conducted the study-SMB, PB, EVR, BKP Analysis-SMB, PB, BKP. Writing the first draft of the manuscript- SMB, PB, EVR. Review and finalizing the manuscript for submission- SMB, PB, EVR, BKP, SK All authors have read and approved the manuscript for submission. Data availability: The data is held by the primary and corresponding authors and can be accessed upon request to the primary and corresponding author. Funding Information: It was a non-funded study. Competing Interest: None References Mouhanna JN, Simms-Cendan J, Pastor-Carvajal S. The Menstrual Cup: Menstrual Hygiene With Less Environmental Impact. JAMA. 2023;329(13):1114–5. UNICEF. Guide to menstrual hygiene materials. Available from: https://www.unicef.org/media/91346/file/UNICEF-Guide-menstrual-hygiene-materials-2019.pdf . (2024, accessed on 20 October 2024). Kothari J, Sawant R, Dwivedi S, Jha C, Bharwada S. Menstrual Cup: A Detailed Qualitative Survey on the Utility and its Role in Menstrual Hygiene. J Women'sHealth Issues Care. 2021;10(11):1–25. Peter A, Abhitha K. Menstrual Cup: A replacement to sanitary pads for a plastic-free period. 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Babagoli MA, Benshaul-Tolonen A, Zulaika G, Nyothach E, Oduor C, Obor D, et al. Cost-Effectiveness and Cost–Benefit Analyses of Providing Menstrual Cups and Sanitary Pads to Schoolgirls in Rural Kenya. Women’s Health Rep. 2022;3(1):773–84. Behera SM, Epari V, Behera P, Patro BK. Promotion and strategies of menstrual cup use among healthcare providers: A primer towards a sustainable solution for menstrual health and hygiene management in India. Indian J Comm Health. 2024;36(1):07–11. Durairaj T, Aparnavi P, Narayanan S, Mahantshetti S, Dhandapani S, Shanmugam J, et al. Utilization of modern menstrual methods and related unmet needs among college going women in Coimbatore district: a descriptive cross-sectional study. BMC Womens Health. 2024;24:78. Bharatnur S, Aishwarya. Awareness of menstrual cup among reproductive age group women. Int J Reprod Contracept Obstet Gynecol. 2023;12(9):2712–20. International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019–21. India: IIPS. 2021. Available from: http://www.rchiips.org/nfhs . (2024, accessed on 20 October 2024). Medhi A, Nigam S, Pendharkar O, Hedge A. Rupali Borkar |. Menstrual Cups: The Sustainable Future for Women Hygiene in India. Available from: https://osf.io/preprints/socarxiv/3vutf . (2024, accessed on 20 October 2024). Eti M, SM S. Knowledge about menstrual cup and its usage among medical students. Int J Reprod Contracept Obstet Gynecol. 2019;8(12):4966. Tables Table 1: Scio-demographic characteristics of the study participants. [N=538] Scio-demographic characteristics Participants [n (%)] Age group (in years) 18-25 >=26 432 (80.3) 136 (19.7) Occupation Staff (Nursing) Staff (Pharmacist) Student (MBBS) Student (Nursing) 249 (46.3) 03 (0.6) 138 (25.6) 148 (27.5) Marital status Unmarried Married Divorced/Separate/Widow 477 (88.7) 58 (10.8) 3 (0.6) Place of residence Urban Rural Semi-Urban 294 (54.6) 169 (31.4) 75 (13.9) Type of Family Nuclear Joint 368 (68.4) 170 (31.6) Religion Hindu Christian Muslim Others* 514 (95.5) 19 (3.5) 3 (0.6) 2 (0.4) Caste General OBC SC ST 318 (59.1) 137 (25.5) 58 (10.8) 25 (4.6) Mother’s education Professional degree or Honours Graduate Intermediate or Diploma High school Middle school Primary school Illiterate 74 (13.7) 166 (30.9) 64 (11.9) 141 (26.2) 44 (8.2) 25 (4.6) 24 (4.5) Education of Head of the Family Professional degree or Honours Graduate Intermediate or Diploma High school Middle school Primary school Illiterate 143 (26.6) 189 (35.1) 65 (12.1) 93 (17.3) 24 (4.5) 14 (2.6) 10 (1.9) Occupation of Head of the family Professional Semi-skilled worker Skilled worker Unskilled worker Unemployed/Retired 208 (38.7) 179 (33) 108 (20) 61 (11.3) 22 (4) Family Income per month (in INR) ≤ 27,882 27,883 – 46,474 46,475 – 69,534 69,535 – 92, 950 92,951 – 1,85,894 ≥ 1,85,895 81 (15.1) 126 (23.4) 105 (19.5) 65 (11.7) 63 (11.7) 98 (18.2) *Others: two participants classified them as tribal, not including them in any religion Table 2: Menstrual Hygiene Management (MHM) practices currently adopted by study participants" (N=538 ) Current MHM practice (consecutive last three cycles) Frequency (n) Percentage (%) Sanitary pads 517 96.10 Menstrual cup 15 2.78 Tampon 04 0.75 Cloth Pad 02 0.37 Total 538 100 Table 3: Unmet Need and Prevalence of Menstrual Cup Use among Study Participants Total Participants Participants who had expressed intent to use a menstrual cup Participants who are currently using the menstrual cup Prevalence of menstrual cup use with 95% CI Burden of unmet need of menstrual cup with 95% CI 538 339 15 2.79% [95% CI 1.57%-4.56%] 95.58% [95% CI 92.81%-97.50%] Table 4: Reasons for Unmet Need for Menstrual Cups Among Study Participants (Multiple Responses Possible) (n=324) Reasons for unmet need for menstrual cup Frequency (n) Percentage (%) Comfortable with sanitary napkins 267 82.4 No adequate knowledge about the menstrual cup 174 53.7 Not Comfortable with the menstrual cup 34 10.5 Need support to use 17 5.2 Insertion Fear 16 4.9 Lack of Privacy (Home/workplace) 14 4.3 Fear of Stuck in the vagina/inside 6 1.9 Social Taboo 5 1.5 Sterilization of the menstrual cup is a problem 4 1.2 *Others 4 1.2 *Other four causes are as follows: Husband denied the cup use-1, changing in the common washroom is difficult-1, fear of adverse event of leakage-1, & reproductive tract infection or irritate the mucosa lining of the cervix or vagina-1 Table 5: Associated factors for menstrual cup use among study participants Variables Unadjusted OR with 95% CI P-value Model 1 Model 2 Model 3 Adjusted OR with 95% CI P-value Adjusted OR with 95% CI P-value Adjusted OR with 95% CI P-value Age (in Year) 18-25 Reference 0.227 Reference .604 Reference 0.625 Reference 0.619 >=26 0.28 (0.04-2.19) 0.52 (0.05-6.12) 0.53 (0.04-6.69) 0.52 (0.04-6.69) Education of Participant Nursing Reference 0.068 Reference 0.085 Reference 0.206 Reference 0.146 MBBS 2.62 (0.93-7.36) 2. 62 (0.88-7.86) 2.96 (0.55-15.90) 3.80 (0.62-23.02) Marital status Unmarried Reference 0.568 Reference 0.671 Reference 0.466 Reference 0.373 Married* 0.55 (0.07-4.27) 1.71 (0.15-20.08) 2.51 (0.21-30.16) 3.11 (0.26-38.00) Knowledge of MC Good 9.65 (3.02-30.87) 0.000 9.66 (2.96-31.52) 0.000 9.88 (2.86-34.12) 0.000 10.81 (3.04-38.49) 0.000 Poor or average Reference Reference Reference Reference Type of Family Nuclear 3.08 (0.69-13.79) 0.142 0.45 (0.10-2.17) 0.322 0.43 (0.09-2.09) 0.298 Joint Reference Reference Reference Reference Mother’s Education** <=High school Reference Reference Reference Reference Intermediate/ Diploma/graduate 1.54 (0.43-5.53) .508 0.86 (0.18-4.11) 0.847 0.93 (0.19-4.59) 0.925 Professional degree 4.17 (1.09-15.95) .037 1.64 (0.24-11.00) 0.610 1.93 (0.26-14.07) 0.517 Family income (in INR) ≤27882 Reference Reference Reference Reference 27883-46474 0.63 (0.13-3.22) 0.583 1.08 (0.19-6.15) 0.929 1.19 (0.21-6.95) 0.844 46475-92950 0.15 (0.02-1.50) 0.107 0.17 (0.02-1.90) 0.149 0.17 (0.02-2.06) 0.165 ≥92951 1.36 (0.35-5.26) 0.657 0.53 (0.08-3.78) 0.530 0.58 (0.08-4.41) 0.597 Caste ST or SC Reference Reference Reference Reference OBC 2.49 (0.27-22.62) 1.88 (0.18-20.19) 0.602 General 2.65 (0.34-21.03) 1.49 (0.15-14.94) 0.734 Residence Rural Reference 0.689 Reference Reference Reference 0.315 Urban 1.27 (0.40-4.04) 0.47 (0.11-2.07) * There were three participants in the category of Divorced/Separate/Widow, which was merged with the unmarried category for analysis ** Illiterate, primary school, middle school and high school merged to form a single category <= High school category for analysis purpose Additional Declarations No competing interests reported. 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Venkata Rao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYJACxgYo/QAmcoAILQYgmtmAZC1sEkQ5il8i+djDGTV/5M3bDx+r/FFhx8DffoDxcAEeLZIz0tINNxwzMJxzJi3tNs+ZZAaJMwkMh2fg0WJw5oyZ5AM2A8YZDDlmtxnbmBkYbjAwHObBo8X+zPlvkg/+GdjP4H9jVvizrZ5BnpAWA/YeNsmNbQaJMyRyzBh42w4zGBDSInG8zUxyZp9x8gyJZ8nSPGeO8xieSWzAq4W/mfmZZM83OdsZ/MkHP/6oqJaTO3748Gd8WjAADyI1jIJRMApGwSggGwAAFIFKOJbNcSoAAAAASUVORK5CYII=","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":true,"prefix":"","firstName":"E.","middleName":"Venkata","lastName":"Rao","suffix":""},{"id":394418641,"identity":"8b0870fd-dec4-47d5-9818-ad66cfefe218","order_by":3,"name":"Binod Kumar Patro","email":"","orcid":"","institution":"All India Institute of Medical Sciences Bhubaneswar","correspondingAuthor":false,"prefix":"","firstName":"Binod","middleName":"Kumar","lastName":"Patro","suffix":""},{"id":394418642,"identity":"b6437c9b-203e-400f-813c-0dea4ccf2599","order_by":4,"name":"Srikanta Kanungo","email":"","orcid":"","institution":"Regional Medical Research Center","correspondingAuthor":false,"prefix":"","firstName":"Srikanta","middleName":"","lastName":"Kanungo","suffix":""}],"badges":[],"createdAt":"2024-12-20 11:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5683546/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5683546/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72610400,"identity":"1ef8a960-a7a2-4a6d-961d-14fde73dc327","added_by":"auto","created_at":"2024-12-30 10:20:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33932,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart of Selection of Participants\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5683546/v1/0160d0fca841f3066b4e99df.png"},{"id":72610401,"identity":"c8a725b3-f117-4213-b67f-b501de7dbbe8","added_by":"auto","created_at":"2024-12-30 10:20:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":56177,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParticipant’s self-rating of knowledge on menstrual cups (N=538)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5683546/v1/84ef1f23d5785d42bc60b133.png"},{"id":72612322,"identity":"504cb44b-cb99-4a98-8316-ced1092d13cf","added_by":"auto","created_at":"2024-12-30 10:28:28","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":42586,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParticipant Awareness, Intent to Use, Knowledge, and Current Practices Related to Menstrual Cup Usage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA. Total number of participants interviewed\u003c/p\u003e\n\u003cp\u003eB. Participants who had seen the menstrual cup\u003c/p\u003e\n\u003cp\u003eC. Participants who had expressed intent to use a menstrual cup\u003c/p\u003e\n\u003cp\u003eD. Participants who had good knowledge related to menstrual cup\u003c/p\u003e\n\u003cp\u003eE. Participants who are currently using the menstrual cup\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5683546/v1/2bbdbc0a798849bd710c7a78.png"},{"id":81287578,"identity":"efc43a06-9e3d-474a-8925-a9ba38e820c2","added_by":"auto","created_at":"2025-04-24 11:08:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1602575,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5683546/v1/89354d7f-5d1a-4ef3-9db4-325734d6b89c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unmet Need, Practice, Perception and Predictors of Menstrual cup Use among Medical and Paramedical Students and Staffs: A Cross-Sectional Study from Eastern India","fulltext":[{"header":"Background","content":"\u003cp\u003eMenstruation is a natural biological process experienced by approximately 1.8\u0026nbsp;billion individuals worldwide every month. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Over the past decade, menstrual health has emerged as a significant public health challenge with growing recognition of the need for affordable and effective menstrual products. However, the most widely available options, such as disposable sanitary pads and tampons, contain high levels of plastic and pose significant environmental challenges. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) In developing countries like India, the improper disposal of sanitary pads remains a significant concern; when disposed of in open fields or landfills, these products not only become breeding grounds for harmful microbes but also contribute to long-lasting environmental pollution, as the plastic content in sanitary napkins takes centuries to decompose. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe menstrual cup (MC) is a bell-shaped device, typically composed of medical-grade silicone, designed to be inserted into the vagina to collect menstrual fluid during menstruation. It can be worn for up to 6\u0026ndash;8 hours, depending on the volume of menstrual flow. Featuring the capacity to be washed and reused for ten years (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), the menstrual cup presents the benefits of cost-effectiveness, reusability, and environmental friendliness. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Menstrual cup use is more acceptable as it eliminates unpleasant odour and sogginess and is worn internally. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Research indicates that menstrual cups are highly accepted by women, who prefer them to traditional products because of their cost-effectiveness and convenience. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Studies further suggest that menstrual cups are a safe choice for managing menstruation, as they do not negatively impact vaginal flora and pose no health risk. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) By providing a reliable and cost-effective option for menstrual hygiene, menstrual cups can effectively meet the needs of women, thus promoting enhanced menstrual health and hygiene overall. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eCommunity awareness regarding the benefits and use of menstrual cups needs to be improved in India. Despite growing global recognition of the advantages of menstrual cups, their adoption in India is predominantly limited to a small, highly educated group of professional women. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) Even among educated women, including healthcare workers and providers, the usage of menstrual cups is minimal. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) As the uptake of menstrual cups is multifactorial and multidimensional, it is critical to understand the cascade of knowledge, their intent to use, and unmet needs regarding its adoption in their routine life/current practice. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) The challenges and associated factors for the uptake of menstrual cups will provide more insights into its local adoption. They can guide further pathway action to improve reproductive health and empower women. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) This study aims to assess the burden of unmet needs related to menstrual cup use, explore the reasons behind these gaps, estimate the prevalence of MC adoption, and identify the key factors associated with its uptake. By addressing these issues, the study seeks to inform future actions that can support more widespread and sustainable adoption of menstrual cups in India, ultimately contributing to better reproductive health outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA cross-sectional study was conducted at a leading tertiary medical college of Odisha, India. Students mostly from eastern India pursue their undergraduate education. The participants included female medical and paramedical students and paramedical staff aged between 18 to 45 years. All females in the specified age range and occupation were included. Exclusions were made for women who had undergone surgical or physiological menopause and those who did not consent to participate. The sample size was calculated based on the unmet need for menstrual cup of 65% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) with an absolute precision of 5%, a design effect of 1.5 to account for the sampling method, and a non-response rate of 10%. The estimated sample size was 578 participants. Simple random sampling was employed to select the participants from the sampling frame. The sampling frame comprised of all female medical and paramedical students and staff aged 18 to 45 in SOA, Bhubaneswar. Unmet need was defined as females who expressed willingness to use menstrual cups if available but were currently not using them. Menstrual cup use was considered when the female has been using a menstrual cup for the last three or more months.\u003c/p\u003e \u003cp\u003eOut of 1766 eligible participants, 578 were selected by simple random sampling. After essential administrative approval, the selected participants were approached at college or home. The participants were provided with an information sheet, and the purpose of the study was explained in detail. After obtaining written informed consent, data were collected using semi-structured questionnaires. The questionnaire included sections on individual characteristics (age, marital status, participant's education, knowledge related to menstrual cups), family factors (mother's education, type of family, family income), and social/environmental factors (residence, caste). Data were initially recorded using Epicollect5, a mobile data collection application that facilitated the systematic entry of participant responses. Once the data collection phase was completed, the collected data were exported from Epicollect5 into Excel for preliminary organisation and cleaning. Subsequently, the cleaned data were imported into Statistical Package for the Social Science \u003cb\u003e(\u003c/b\u003eSPSS) version 27.0 for detailed statistical analysis. Bivariate and multivariate logistic regression models were used to analyse the data. Three models were constructed: Model 1 Included individual characteristics (age, marital status, participant's education, and knowledge of menstrual cups). Model 2: Added family factors (mother's education, type of family, family income) and variables in Model 1. Model 3: incorporated social and environmental factors (residence, caste) and the variables in Model 2. The regression models were used to identify factors associated with menstrual cup use among the study participants. The study received approval from the institute ethics committee (SOA, Bhubaneswar) wide ref no./IEC/IMS.SH/SOA/2022/427 dated 14th October 2022. Confidentiality and anonymity of the participants' data were strictly maintained throughout the study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of 578 participants, 40 were excluded; finally, 538 were interviewed and included in the analysis (Figure 1). The mean (SD) age of participants was 23 ± 4.2 years. The mean age at menarche was 13±1.3 years. Most participants (80.3%) were\u0026nbsp;between 18-25 years, while 19.7% were aged 26 years or older. Among participants, 46.3% were nursing staff, 25.6% were MBBS students, 27.5% were nursing students, and 0.6% were pharmacists. \u0026nbsp;Majority participants (88.7%) were unmarried. Around half of the participants (54.6%) lived in urban areas and 13.9% in semi-urban areas.Regarding family structure, 68.4% of participants belonged to nuclear families, while 31.6% were from joint families. As for religion, 95.5% of the participants \u0026nbsp;identified as Hindu, 3.5% as Christian, 0.6% as Muslim, and 0.4% as other religions. Two participants identified as tribal without specifying any particular religion. Caste-wise, 59.1% of participants belonged to the general category, 25.5% to OBC, 10.8% to SC, and 4.6% to ST. Approximately two-thirds of participants (68.4%) lived in a nuclear family. Regarding maternal education, 13.7% of the participants’ mothers held professional degrees or honours, 30.9% were graduates, 11.9% had intermediate or diploma qualifications, 26.2% completed high school, 8.2% finished middle school, 4.6% had primary schooling, and 4.5% were illiterate. Concerning the occupation of the family heads, 38.7% were professionals, 33% were semi-skilled workers, 20% were skilled workers, 11.3% were unskilled workers, and 4% were either unemployed or retired (Table 1). Family income varied, with 15.1% earning up to INR 27,882 per month, 23.4% between INR 27,883 – 46,474, 19.5% between INR 46,475 – 69,534, 11.7% between INR 69,535 – 92,950, 11.7% earning between INR 92,951 – 1,85,894, and 18.2% earning INR 1,85,895 or more.(Table 1)\u003c/p\u003e\n\u003cp\u003eOut of 538 participants, 517 (96.1%) participants reported that they were using sanitary pads as the current menstrual hygiene management (MHM) practice, followed by menstrual cups (n=15, 2.78%), tampons (n=4, 0.75%) and cloth pads (n=2, 0.37%) (Table 2). Menstrual cup was seen by 433 (80.48%) participants and, 126 (23.6%) participants rated their knowledge of menstrual cups as good, 218 (40.5%) as average, and 193 (35.9%) as poor (Figures 2 and 3). Of the 538 participants, 339 intend to use the menstrual cup; however, only 15 participants currently use the menstrual cup.\u0026nbsp;The burden of unmet need was 95.58% [95% CI 92.81%-97.50%]. The prevalence\u0026nbsp;of menstrual\u0026nbsp;cup use was 2.79% [95% CI 1.57%-4.56%]. (Table 3)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary reasons for the unmet need for menstrual cups were participants' comfort with sanitary napkins (82.4%, 267 participants) and insufficient knowledge about menstrual cups (53.7%, 174 participants). Additionally, 5.2% (17 participants) expressed the need for support in using the cup effectively, while fear of insertion was a concern for 4.9% (16 participants). A lack of privacy at home or in the workplace was reported as a barrier by 4.3% (14 participants). Other concerns included fear of the cup becoming stuck inside the vagina (1.9%), social taboos surrounding its use (1.5%), and difficulties with sterilisation (1.2%). (Table 4) In the bivariate analysis, knowledge about menstrual cups [OR 9.65 (95% CI 3.02–30.87)] and mother’s education [OR 4.17 (95% CI 1.09–15.95)] were found to be associated with menstrual cup use. However, in model 3, after adjusting for individual, family, and social factors, women who rated their knowledge of menstrual cups as good were significantly more likely to adopt menstrual cups for menstrual hygiene management compared to those with poor or average knowledge [aOR 10.81 (95% CI 3.04–38.49)], while mother’s education became non-significant [aOR 1.93 (95% CI 0.26–14.07)]. (Table 5) Age, education of participants, marital status, type of family [aOR 0.43 (95% CI 0.09-2.09)], family income, caste and residence [aOR 0.47 (95% CI 0.11-2.07)] were not associated with menstrual cup use among study participants. (Table 5)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study shed light on the current landscape of menstrual cup adoption in eastern India. The prevalence of menstrual cup use among the study population was notably low, at 2.78%. However, the NFHS-5 survey, (2019-21) has reported only 0.3% of females aged 15 to 24 have used menstrual cups. Though the prevalence of menstrual cups was low, it was higher than the national estimate of NFHS, which can be attributed to the difference in the study population. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) This discrepancy may also be due to the regional variations in menstrual cup adoption, which differences could influence awareness, socioeconomic factors, cultural norms, and access to menstrual health products across different parts of the country. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Similarly, the unmet need was 95.6%, indicating a significant disparity between intention and actual usage of menstrual cups, with only a small fraction of participants currently using them despite a substantial expressed interest. This highlights an apparent discrepancy between awareness and adoption, suggesting that various barriers prevented their actual uptake. A study from South India reported a higher prevalence of menstrual cup use at 6%. However, a significant majority, 80% of the study participants, were aware of the menstrual cup, and 65% said they would use it if it were available.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) The differences in findings between this study and the South Indian study could be attributed to regional variations and contextual factors despite similarities in the study populations. These variations highlight the need for targeted interventions to address local barriers and enhance the adoption of menstrual cups in different regions of India.\u003c/p\u003e \u003cp\u003eA key determinant influencing the adoption of menstrual cups is the level of knowledge about these products. Participants rated their knowledge as good and were over ten times more likely to adopt menstrual cups for hygiene management than those with poor or average expertise. This highlights the crucial role of educational and awareness campaigns in promoting menstrual cups as a viable alternative to traditional menstrual products. Interestingly, while maternal education initially appeared to be a significant factor in the bivariate analysis, this association diminished when adjusted for other individual, family, and social factors in the multivariate model. This suggests that although maternal education may initially impact attitudes toward menstrual health practices, broader socio-environmental factors play a more substantial role in shaping actual behaviour regarding menstrual cup adoption. Most participants preferred sanitary napkins, possibly due to their limited exposure to menstrual cups and a lack of direct comparative experience. Participants\u0026rsquo; feedback on the high unmet need for menstrual cups reveals several barriers to their uptake, including inadequate knowledge, lack of support during initial use, fear of insertion, privacy concerns, myths regarding vaginal obstruction, and prevailing societal taboos related to menstruation. Including the above reasons during the MHM interventions is essential, as it could enhance acceptance and increase menstrual cup adoption among women.\u003c/p\u003e \u003cp\u003eStudies also found menstrual cups pose no health hazards to females. It doesn\u0026rsquo;t cause bacterial or yeast infection on prolonged use since it is made of nonreactive medical-grade silicon. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Most women feel comfortable switching to menstrual cups thoroughly after their second or third use. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Education and awareness are pivotal in introducing and popularising menstrual cups among women in India. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Due to limited exposure, many women may not be familiar with menstrual cups or lack a comprehensive understanding of how to use them effectively. By offering education on the anatomy of the female reproductive system along with a focus on menstrual cups, misconceptions and myths surrounding their usage can be addressed. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Support and guidance are essential for women who are new to using menstrual cups, particularly during the initial stages of adoption. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Offering comprehensive information on inserting and removing the cup and addressing common concerns such as leaks and discomfort can significantly enhance women's confidence in using menstrual cups effectively. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Providing ongoing support through various channels ensures that women have the assistance they need to overcome any challenges they may encounter. By offering handholding support and fostering a supportive environment, we can empower women to embrace menstrual cups as a sustainable and comfortable menstrual hygiene option for the long term. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) The study's limitation is that the study's results can't be generalised to all the reproductive age group population as the study was conducted among a specific population like medical and paramedical students and staff.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDespite the proven benefits of menstrual cups, their usage remains low, and unmet need is high. A strong link exists between having good knowledge of menstrual cups and the likelihood of using them. However, limited awareness of menstrual cups, the need for support during initial use and myths and social barriers related to menstrual cups are critical barriers to adoption. To address this, targeted public health efforts are essential. These should focus on increasing knowledge, providing clear guidance, and supporting new users. Promoting menstrual cups as a sustainable and practical option can help meet the growing demand for effective menstrual hygiene management among women of reproductive age.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eaOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eadjusted Odd Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eINR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIndian Rupee\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMBBS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBachelor of Medicine and Bachelor of Surgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMHM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMenstrual Hygiene Management\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNFHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Family Health Survey\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOther Backward Classes\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdd Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eScheduled Caste\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eScheduled Tribe\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSOA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSiksha \u0026lsquo;O\u0026rsquo; Anusandhan\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe study received approval from the institute ethics committee (SOA, Bhubaneswar) wide ref no./IEC/IMS.SH/SOA/2022/427 dated 14\u003csup\u003eth\u003c/sup\u003e October 2022. The study adhered to the standard guidelines of the Declaration of Helsinki. Written informed consent was obtained from study participants before data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution:\u0026nbsp;\u003c/strong\u003eConceptualisation-SMB, PB, EVR, BKP \u0026amp; SK Conducted the study-SMB, PB, EVR, BKP Analysis-SMB, PB, BKP. \u0026nbsp;Writing the first draft of the manuscript- SMB, PB, EVR. Review and finalizing the manuscript for submission- SMB, PB, EVR, BKP, SK All authors have read and approved the manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eThe data is held by the primary and corresponding authors and can be accessed upon request to the primary and corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Information:\u003c/strong\u003e It was a non-funded study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest:\u003c/strong\u003e None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMouhanna JN, Simms-Cendan J, Pastor-Carvajal S. The Menstrual Cup: Menstrual Hygiene With Less Environmental Impact. JAMA. 2023;329(13):1114\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNICEF. Guide to menstrual hygiene materials. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unicef.org/media/91346/file/UNICEF-Guide-menstrual-hygiene-materials-2019.pdf\u003c/span\u003e\u003cspan address=\"https://www.unicef.org/media/91346/file/UNICEF-Guide-menstrual-hygiene-materials-2019.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (2024, accessed on 20 October 2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKothari J, Sawant R, Dwivedi S, Jha C, Bharwada S. Menstrual Cup: A Detailed Qualitative Survey on the Utility and its Role in Menstrual Hygiene. J Women'sHealth Issues Care. 2021;10(11):1\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeter A, Abhitha K. Menstrual Cup: A replacement to sanitary pads for a plastic-free period. Materials Today: Proceedings. 2021;47(15):5199\u0026ndash;202.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E, et al. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. Lancet Public Health. 2019;4(8):e376\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSB K, Bhandary A. Menstrual cup: awareness among reproductive women. Int J Reprod Contracept Obstet Gynecol. 2020;9(4):1382.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGanz C, Lever E, Bredenkamp J, Mponda L, Ramaru T, Mazonde W, et al. The Understanding and Perception of the Menstrual Cup Among Medical Students. J Obstet Gynecol India. 2022;72(5):439\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeghana S, Gomathy E. Knowledge, attitude, and practices regarding menstrual cup among reproductive women in a rural tertiary care Hospital. Int J Clin Obstet Gynecol. 2021;5(2):211\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKakani CR, Bhatt JK. Study of adaptability and efficacy of menstrual cup in managing menstrual health and hygiene. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):3045.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBabagoli MA, Benshaul-Tolonen A, Zulaika G, Nyothach E, Oduor C, Obor D, et al. Cost-Effectiveness and Cost\u0026ndash;Benefit Analyses of Providing Menstrual Cups and Sanitary Pads to Schoolgirls in Rural Kenya. Women\u0026rsquo;s Health Rep. 2022;3(1):773\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehera SM, Epari V, Behera P, Patro BK. Promotion and strategies of menstrual cup use among healthcare providers: A primer towards a sustainable solution for menstrual health and hygiene management in India. Indian J Comm Health. 2024;36(1):07\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDurairaj T, Aparnavi P, Narayanan S, Mahantshetti S, Dhandapani S, Shanmugam J, et al. Utilization of modern menstrual methods and related unmet needs among college going women in Coimbatore district: a descriptive cross-sectional study. BMC Womens Health. 2024;24:78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBharatnur S, Aishwarya. Awareness of menstrual cup among reproductive age group women. Int J Reprod Contracept Obstet Gynecol. 2023;12(9):2712\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInternational Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019\u0026ndash;21. India: IIPS. 2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.rchiips.org/nfhs\u003c/span\u003e\u003cspan address=\"http://www.rchiips.org/nfhs\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (2024, accessed on 20 October 2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMedhi A, Nigam S, Pendharkar O, Hedge A. Rupali Borkar |. Menstrual Cups: The Sustainable Future for Women Hygiene in India. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://osf.io/preprints/socarxiv/3vutf\u003c/span\u003e\u003cspan address=\"https://osf.io/preprints/socarxiv/3vutf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (2024, accessed on 20 October 2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEti M, SM S. Knowledge about menstrual cup and its usage among medical students. Int J Reprod Contracept Obstet Gynecol. 2019;8(12):4966.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Scio-demographic characteristics of the study participants. [N=538]\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScio-demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group (in years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003e18-25\u003c/p\u003e\n \u003cp\u003e\u0026gt;=26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e432 (80.3)\u003c/p\u003e\n \u003cp\u003e136 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003eStaff (Nursing)\u003c/p\u003e\n \u003cp\u003eStaff (Pharmacist)\u003c/p\u003e\n \u003cp\u003eStudent (MBBS)\u003c/p\u003e\n \u003cp\u003eStudent (Nursing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e249 (46.3)\u003c/p\u003e\n \u003cp\u003e03 (0.6)\u003c/p\u003e\n \u003cp\u003e138 (25.6)\u003c/p\u003e\n \u003cp\u003e148 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 643px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced/Separate/Widow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e477 (88.7)\u003c/p\u003e\n \u003cp\u003e58 (10.8)\u003c/p\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 643px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003cp\u003eSemi-Urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e294 (54.6)\u003c/p\u003e\n \u003cp\u003e169 (31.4)\u003c/p\u003e\n \u003cp\u003e75 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 643px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003eNuclear\u003c/p\u003e\n \u003cp\u003eJoint\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e368 (68.4)\u003c/p\u003e\n \u003cp\u003e170 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 643px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003eHindu\u003c/p\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003cp\u003eOthers*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e514 (95.5)\u003c/p\u003e\n \u003cp\u003e19 (3.5)\u003c/p\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003cp\u003e2 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 643px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaste\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003cp\u003eOBC\u003c/p\u003e\n \u003cp\u003eSC\u003c/p\u003e\n \u003cp\u003eST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e318 (59.1)\u003c/p\u003e\n \u003cp\u003e137 (25.5)\u003c/p\u003e\n \u003cp\u003e58 (10.8)\u003c/p\u003e\n \u003cp\u003e25 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 643px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMother\u0026rsquo;s education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003eProfessional degree or Honours\u003c/p\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003cp\u003eIntermediate or Diploma\u003c/p\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e74 (13.7)\u003c/p\u003e\n \u003cp\u003e166 (30.9)\u003c/p\u003e\n \u003cp\u003e64 (11.9)\u003c/p\u003e\n \u003cp\u003e141 (26.2)\u003c/p\u003e\n \u003cp\u003e44 (8.2)\u003c/p\u003e\n \u003cp\u003e25 (4.6)\u003c/p\u003e\n \u003cp\u003e24 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 643px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation of Head of the Family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003eProfessional degree or Honours\u003c/p\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003cp\u003eIntermediate or Diploma\u003c/p\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e143 (26.6)\u003c/p\u003e\n \u003cp\u003e189 (35.1)\u003c/p\u003e\n \u003cp\u003e65 (12.1)\u003c/p\u003e\n \u003cp\u003e93 (17.3)\u003c/p\u003e\n \u003cp\u003e24 (4.5)\u003c/p\u003e\n \u003cp\u003e14 (2.6)\u003c/p\u003e\n \u003cp\u003e10 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 643px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation of Head of the family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003eProfessional\u003c/p\u003e\n \u003cp\u003eSemi-skilled worker\u003c/p\u003e\n \u003cp\u003eSkilled worker\u003c/p\u003e\n \u003cp\u003eUnskilled worker\u003c/p\u003e\n \u003cp\u003eUnemployed/Retired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e208 (38.7)\u003c/p\u003e\n \u003cp\u003e179 (33)\u003c/p\u003e\n \u003cp\u003e108 (20)\u003c/p\u003e\n \u003cp\u003e61 (11.3)\u003c/p\u003e\n \u003cp\u003e22 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 643px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily Income per month (in INR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 425px;\"\u003e\n \u003cp\u003e\u0026le; 27,882\u003c/p\u003e\n \u003cp\u003e27,883 \u0026ndash; 46,474\u003c/p\u003e\n \u003cp\u003e46,475 \u0026ndash; 69,534\u003c/p\u003e\n \u003cp\u003e69,535 \u0026ndash; 92, 950\u003c/p\u003e\n \u003cp\u003e92,951 \u0026ndash; 1,85,894\u003c/p\u003e\n \u003cp\u003e\u0026ge; 1,85,895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e81 (15.1)\u003c/p\u003e\n \u003cp\u003e126 (23.4)\u003c/p\u003e\n \u003cp\u003e105 (19.5)\u003c/p\u003e\n \u003cp\u003e65 (11.7)\u003c/p\u003e\n \u003cp\u003e63 (11.7)\u003c/p\u003e\n \u003cp\u003e98 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Others: two participants classified them as tribal, not including them in any religion\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Menstrual Hygiene Management (MHM) practices currently adopted by study participants\u0026quot; (N=538\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003e)\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent MHM practice (consecutive last three cycles)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;Sanitary pads\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e517\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e96.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMenstrual cup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e15\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eTampon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eCloth Pad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e538\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e \u003cstrong\u003eUnmet Need and Prevalence of Menstrual Cup Use among Study Participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"813\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants who had expressed intent to use a menstrual cup\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants who are currently using the menstrual cup\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence of menstrual cup use with 95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurden of unmet need of menstrual cup with 95% CI\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.79% [95% CI 1.57%-4.56%]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e95.58% [95% CI 92.81%-97.50%]\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Reasons for Unmet Need for Menstrual Cups Among Study Participants (Multiple Responses Possible) (n=324)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Reasons for unmet\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eneed for menstrual cup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eComfortable with sanitary napkins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e82.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eNo adequate knowledge about the menstrual cup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eNot Comfortable with the menstrual cup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eNeed support to use\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eInsertion Fear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eLack of Privacy (Home/workplace)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eFear of Stuck in the vagina/inside\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eSocial Taboo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eSterilization of the menstrual cup is a problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003e*Others\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Other four causes are as follows: Husband denied the cup use-1, changing in the common washroom is difficult-1, fear of adverse event of leakage-1, \u0026amp; reproductive tract infection or irritate the mucosa lining of the cervix or vagina-1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Associated factors for menstrual cup use among study participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"973\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eUnadjusted OR with 95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR with 95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR with 95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR with 95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 973px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (in Year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e18-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.619\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026gt;=26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.28 (0.04-2.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.52 (0.05-6.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.53 (0.04-6.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e0.52 (0.04-6.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 973px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation of Participant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eNursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReference\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMBBS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e2.62 (0.93-7.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e2. 62 (0.88-7.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e2.96 (0.55-15.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e3.80 (0.62-23.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 973px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eUnmarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReference\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.373\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.55 (0.07-4.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1.71 (0.15-20.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e2.51 (0.21-30.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e3.11 (0.26-38.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 973px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge of MC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eGood\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.65 (3.02-30.87)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e9.66 (2.96-31.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.88 (2.86-34.12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.81 (3.04-38.49)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003ePoor or average\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 973px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Family\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eNuclear\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e3.08 (0.69-13.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.45 (0.10-2.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e0.43 (0.09-2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eJoint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReference\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 973px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMother\u0026rsquo;s Education**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026lt;=High school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReference\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eIntermediate/ Diploma/graduate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1.54 (0.43-5.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.86 (0.18-4.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e0.93 (0.19-4.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eProfessional degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.17 (1.09-15.95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1.64 (0.24-11.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e1.93 (0.26-14.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 973px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily income (in INR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026le;27882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReference\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e27883-46474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.63 (0.13-3.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1.08 (0.19-6.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e1.19 (0.21-6.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.844\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e46475-92950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.15 (0.02-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.17 (0.02-1.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e0.17 (0.02-2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026ge;92951\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1.36 (0.35-5.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.53 (0.08-3.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e0.58 (0.08-4.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 973px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaste\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eST or SC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReference\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eOBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e2.49 (0.27-22.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e1.88 (0.18-20.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e2.65 (0.34-21.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e1.49 (0.15-14.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 973px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReference\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eUrban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1.27 (0.40-4.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e0.47 (0.11-2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* There were three participants in the category of Divorced/Separate/Widow, which was merged with the unmarried category for analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e** Illiterate, primary school, middle school and high school merged to form a single category\u003cstrong\u003e\u0026nbsp;\u0026lt;=\u003c/strong\u003eHigh school category for analysis purpose\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Unmet Need, Menstrual Cup, India","lastPublishedDoi":"10.21203/rs.3.rs-5683546/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5683546/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMenstrual cups are a cost-effective, sustainable, and safe alternative to other menstrual products. However, they are less popular or not widely used, such as sanitary pads. The study aimed to estimate the unmet need, prevalence and associated factors of menstrual cup use.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study was conducted in a tertiary medical college in Odisha, eastern India. All female medical and paramedical students and staff aged 18\u0026ndash;45 years were included in the study. Women with surgical/physiological menopause and those denied consent to participate in the study were excluded. Unmet need was defined as females willing to use menstrual cups but not using them currently. Bivariate and multivariate logistic regression models were used to find the factors associated with menstrual cup use. Model 1 analysed individual characteristics (age, marital status, participant's education, and knowledge related to menstrual cups). Model 2 added family factors (mother's education, type of family, and family income and in final model 3 incorporated social/environmental factors (residence and caste).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOut of 538 participants, 339 intend to use the menstrual cup; however, only 15 participants use the menstrual cup currently. The unmet need was 95.58% [95% CI 92.81%-97.50%]. The prevalence of menstrual cup use is 2.79% [95% CI 1.57%-4.56%]. Women who rated their knowledge of menstrual cups as good were likelier to adopt menstrual cups as menstrual hygiene management than those with poor/average knowledge [OR 10.81 (95% CI 3.04\u0026ndash;38.49)]. Mother\u0026rsquo;s education was significant in bivariate analysis [OR 4.17 (95% CI 1.09\u0026ndash;15.95)]; however, it was not significant in model 3. The reasons for unmet needs were comfortable with sanitary napkins, no adequate knowledge about menstrual cups, the requirement of support during menstrual cup use, fear of insertion, lack of privacy, fear of being struck inside the vagina, and social taboos.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDespite the benefits, menstrual cup use remains low while unmet needs are high. A strong association exists between individuals with good knowledge of menstrual cups and their likelihood of using them. To address this, public health initiatives are necessary to enhance knowledge and provide support, promoting menstrual cups as a sustainable solution for menstrual hygiene management among women of reproductive age.\u003c/p\u003e","manuscriptTitle":"Unmet Need, Practice, Perception and Predictors of Menstrual cup Use among Medical and Paramedical Students and Staffs: A Cross-Sectional Study from Eastern India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-30 10:20:24","doi":"10.21203/rs.3.rs-5683546/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"315e082e-72a7-4759-9b96-a6ad4156823e","owner":[],"postedDate":"December 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-24T11:08:30+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-30 10:20:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5683546","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5683546","identity":"rs-5683546","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}