Drivers of Hygienic Menstrual Practices among Reproductive-Age Women: Evidence from Nepal Demographic Health Survey-2022

Drivers of Hygienic Menstrual Practices among Reproductive-Age Women: Evidence from Nepal Demographic Health Survey-2022 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Drivers of Hygienic Menstrual Practices among Reproductive-Age Women: Evidence from Nepal Demographic Health Survey-2022 Nihal Hasan, Pradeep Kumar, Rahul Rajak This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5286445/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Mar, 2025 Read the published version in Reproductive Health → Version 1 posted 11 You are reading this latest preprint version Abstract Background: Exclusive use of hygienic methods during menstruation has not received adequate attention in Nepal, with limited research utilizing nationally representative data. Therefore, this study explored the prevalence and factors influencing exclusive hygienic menstrual practices among women of reproductive age in Nepal. Methods: This study included 13,066 reproductive-age women from the Nepal Demographic and Health Survey (NDHS-2022). A binary logistic regression model was applied to identify significant factors of exclusive use of hygienic methods among women in Nepal. To quantify the proportion of the total variance attributable to differences between communities. The concentration Index (CI) and Concentration curve (CC) were also calculated to measure the socio-economic inequality of exclusive use of hygienic methods among reproductive agewomen. Results: Only 48% of Nepalese women aged 15- 49 years used exclusively hygienic methods to prevent bloodstains during menstruation. The results of the multivariate model revealed that young women aged 15-24 (AOR=2.51, p<0.001), women with 10 years and above education (AOR=1.98, p<0.001) from the richest wealth quintile (AOR=2.16, p<0.001), never married women (AOR=1.44, p<0.001), owned a smartphone (AOR=1.41, p<0.001) and women with exposure to mass media at least once a week (AOR=1.36, p<0.001) are more likely to use hygienic methods as compared with their counterparts. The results from the concentration curve also demonstrated that exclusive use of hygiene methods among women is concentrated in women from higher economic backgrounds (CI: 0.21). Among the geographical regions of Nepal, the highest inequality was witnessed in Madhesh province (CI: 0.25), followed by Bagmati province (CI: 0.22). Conclusions: The findings suggest the need for multidimensional interventions and educational programs targeting socioeconomically vulnerable women to address unhygienic menstrual practices. Also, there is a need to educate adult women on biological facts and good hygienic practices, as they can impose cultural taboos and restrictions on the next generation. Menstrual hygiene Reproductive age women Inequality Nepal Figures Figure 1 Figure 2 Figure 3 Introduction Menstruation is a natural and biological process that every woman experiences throughout her reproductive years. Maintaining menstrual hygiene is a process in which “women and adolescent girls use a clean menstrual management material to absorb and collect blood, that can be changed in privacy as often as necessary for the duration of the period, using soap and water for washing the body as required and having access to facilities to dispose of used menstrual management materials” [ 1 ]. However, in Nepal, menstruation is perceived as a taboo, stigma, and uncomfortable topic, and people are ashamed of the disclosure of their menarche [ 2 ]. Due to poor knowledge and awareness about menstrual hygiene, women face significant challenges in managing menstruation hygienically [ 3 , 4 ]. To ensure menstruation hygienically and with dignity, menstrual hygiene management (MHM) has received particular attention from Sustainable Development Goals 6.1 and 6.2, which aim for the ‘access to adequate and equitable sanitation and hygiene for all’, paying particular attention to the needs of women and girls. It is estimated that worldwide, 500 million women lack access to menstrual products and adequate facilities for MHM [ 5 ]. According to a recent study in Nepal, every day, approximately 2,90,000 women and girls experience menstruation [ 6 ]. However, around 39% of women still not use an appropriate material during their last menstruation [ 7 ]. To recognize the importance of promoting menstruation hygiene practices, in the year of 2020, Government of Nepal (GoN) introduced a national sanitary pad (distribution and management) procedure to distribute free sanitary pads to government-aided schools [ 8 ]. Despite GoN efforts, there is still a significant portion of women who are incapable of achieving exclusive use of hygienic methods of menstruation practices. A systematic review-based study explained that Nepal's socio-demographic and cultural features lead to unhygienic menstrual practices, such as use of unhygienic menstrual products, lack of information about menstruation hygiene, and access to safe water and clean toilets [ 4 ]. Moreover, previous studies conducted on Nepalese women reported that an unhygienic sanitation practice during menstruation exposes women to risks of various urogenital infections, including reproductive tract infections (RTIs) and urinary tract infections (UTIs) [ 9 , 10 ]. Unhygienic menstrual practices are also associated with compromising women's educational and economic opportunities and resulting in a diminished quality of life [ 11 , 12 ]. Therefore, the exclusive use of hygienic methods during menstruation is a major public health and social issue in Nepal. Numerous studies reported that exclusive use of menstrual hygiene methods is influenced by a variety of factors, including age, age at menarche, educational status, marital status, wealth status, place of residence, source of water, toilet facility, and media exposure, etc [ 2 – 4 ]. For instance, the level of knowledge regarding menstrual hygiene management, such as use of sanitary pads, frequency in changing pads, bathing and cleaning genital areas during menstruation, and appropriate disposal of used sanitary pads, is significantly associated with age and place of residence [ 3 , 13 ]. Studies have revealed that urban women and girls have more access to sanitary pads as compared to their rural counterparts [ 3 , 10 ]. Evidence shows that only 9% of women from rural Nepal use sanitary pads, while 89% still use cloth during menstruation. Meanwhile, in urban areas, 34% of women use sanitary pads, and 64% use clothing during their periods [ 14 ]. In many parts of Nepal, menstrual practices are deeply influenced by social and cultural norms. According to UNICEF, more than two-thirds of women in Nepal did not participate in regular activities while menstruating [ 15 ]. A study conducted in three districts within the Terai region in Nepal explained that three out of four women experienced two or more types of menstrual restriction [ 16 ]. Also, cultural customs like ‘Chhaupadi’ ( a custom in which women and girls are banished to isolated huts or sheds and experience grossly unhygienic conditions while menstruating ) exacerbate unhygienic menstrual management as highlighted by many studies [ 2 , 17 ]. Although this practice was declared illegal by Nepal’s Supreme Court in May 2005 and was criminalized under the Criminal Code Act (2017), the practice still exists in some areas and communities in Nepal [ 2 , 18 ]. In Nepal, most studies on mensuration hygiene particularly focused on adolescent girls and were centered on rural communities or specific geographical areas [ 6 , 10 , 19 ]. Very limited studies have investigated the national level and examined the factors associated with hygiene menstruation practices in reproductive-age women. To our knowledge, no study has been conducted in Nepal that has examined the prevalence of exclusive use of hygienic methods among women (15–49 years) using nationally representative data. To fill this gap, the present study hypothesized that the exclusive use of menstrual hygiene practices was positively associated with socio-demographic, socio-cultural, economic, and factors related to the ecological and provincial distribution of Nepal. Thus, the present study aims to assess the factors influencing the exclusive use of hygienic methods during menstruation among reproductive-age women in Nepal. Data and Methods Data The study utilized data from the 2022 Nepal Demographic and Health Survey (NDHS), conducted between January 5 - June 22, 2022. The survey collected information on fertility, marriage, family planning, breastfeeding practices, nutrition, food insecurity, maternal and child health, childhood mortality, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), women’s empowerment, domestic violence, fistula, mental health, accident and injury, disability, and other health-related issues such as smoking, knowledge of tuberculosis, and prevalence of hypertension. Nepal Demographic and Health Survey (NDHS) used a sampling frame from an updated version of the 2011 Nepal Population and Housing Census (NPHC) provided by the National Statistical Office. The NDHS-2022 considered wards from the 2011 census as sub-wards, the smallest administrative unit for the survey. The survey used a stratified sample that was selected in two stages. Stratification was done by dividing each of the seven provinces into urban and rural areas, which together formed the sampling stratum for that province. A total of 14 sampling strata were created in this way. In the first sampling stage, 476 primary sampling units (PSUs) were selected with probability proportional to PSU size and with independent selection in each sampling stratum within the sample allocation. Among the 476 PSUs, 248 were from urban areas and 228 from rural areas. Detailed sampling design and data collection procedure are given elsewhere [ 7 ]. A total of 13,786 households, 14,845 women and 4,913 men aged 15–49 years, were successfully interviewed, with a response rate of 99.7%, 97.4%, and 94.8%, respectively. The final sample size of this study was 13065 women aged 15–49 years. Outcome variable NDHS-2022 asked a multiple-response question to eligible female respondents about the specified materials used to collect or absorb blood from the most recent menstrual period during their menstruation to prevent blood stains from becoming evident. Response options included ten categories: i) reusable sanitary pads, ii) disposable sanitary pads, iii) tampons, iv) menstrual cups, v) cloth, vi) toilet paper, vii) cotton wool, viii) underwear only, ix) other, and x) nothing. The first four and vi, vii of these are labelled as hygienic methods, and the remaining as unhygienic. The outcome variable of this study is “exclusive use of hygienic methods”. A woman is considered “an exclusive user of hygienic methods” if she uses hygienic methods only. Any woman who uses either unhygienic methods or a combination of hygienic and unhygienic methods is considered “not an exclusive user of hygienic methods”. Predictor variables Variables Description Age : Respondent’s age collected at the time of the survey was classified into three groups: “15– 24 years”, “25–34 years, and “35 + years”. Age at menarche : Age at menarche were grouped into following categories - ‘less than 13 years’, ‘13–15 years’, ‘more than 15 years’, and “Don’t know” (for women who do not remember the age.) Marital status : The survey collected the current marital status as follows: 0 “Never in union,” 1 “married,” 2 “living with a partner,” 3 “widowed,” 4 “divorced,” and 5 “no longer living together/separated.” However, for this study, we grouped it into two categories: (0) “Never married” and (1,2,3,4,5) “Ever married” . Years of schooling : Education in single years of schooling was recoded into the following categories: “< 5 years”, “5–9 years”, and “10 + years”. Wealth index : Wealth quintile variable was recoded into three categories: “Poor,” “Middle,” and “Rich.” Religion : Religion was recorded as “Hindu” and “Non-Hindu” Type of home : Type of home is created based on the respondent’s relationship with the household head; three categories were created, − marital home, natal home, and household head. ‘Marital home’ (1) includes wife, daughter-in-law, mother, mother-in-law, co-spouse, sister-in-law; ‘natal home’ (2) includes daughter, granddaughter, sister, other relative, adopted/foster child, not relative, niece by blood; ‘Head’ (3) respondents who are household head themselves [Ref.] Restrictions on activities during menstrual period : Respondents reported the activities they are excluded from during the menstrual period, like entering the temple, getting involved in religious activities, touching or cooking food, eating with family members, staying in the main house, touching plants, touching other people, touching cattle, fetching water, sleep with husband, and other. A variable was created- the number of activities respondents were excluded from then recoded into four categories- 0 No restriction, 1–2 restrictions, 3–4 restrictions, and 5 + restrictions. Households using improved sanitation facility : Households that were using improved sanitation facilities without sharing it with any other household were recorded as “Yes,” otherwise, “No.” Improved sanitation facility includes toilets of the following types: flush to piped sewer systems, septic tanks, pit latrines, or an unknown destination; ventilated improved pit (VIP; pit latrines with slabs; and composting toilets. Ecological region : Nepal is classified into three ecological regions- Mountain, Hill, and Terai. Province : The 7 provinces of Nepal are Koshi, Madhesh, Bagmati, Gandaki, Lumbini, Karnali, and Sudurpashchim. Residence : Residence was categorized into two groups: “Urban” and “Rural” Variables Description Occupation of the woman : Respondent’s occupation was grouped into three categories: 1 “Not working”; 2 “White collar” includes professional/technical/managerial, clerical, and sales; 3 “Blue collar” includes agricultural-self-employed, skilled manual, unskilled manual, and others. Owned smartphone : Whether a respondent owns a smartphone by herself. Recorded as “Yes” and “No” Exposure to any mass media : Respondents were asked how often they read newspapers or magazines, listen to the radio, and watch television in three different variables in the following categories: 0 “Not at all,” 1 “Less than once a week,” and 2 “At least once a week.” In this study, we combined all three sources to create exposure to any mass media (Newspapers or magazines/ Radio/ Television). Community education : Communities were grouped into two groups based on the proportion of women with less than 5 years of schooling in PSUs. 1 “High” if the proportion was less than the national average and 2 “Low” otherwise. Community wealth : Communities were grouped into two groups based on the proportion of poor women in PSUs. 1 “High” if proportion was less than the 25th percentile and 2 “Low” otherwise. Community exposure to media : Communities were grouped into two groups based on the proportion of women exposed to mass media at least once a week in PSUs. 1 “High” if proportion was more than the 75th percentile and 2 “Low” otherwise Statistical analysis The analysis of this study is based on reproductive-age women (aged 15–49 years) in Nepal sampled in the NDHS-2022. The study used bivariate analysis to examine the association between the exclusive use of hygienic methods and other socio-demographic predictors. The chi-square test was applied to observe the significant association between them. Further, a multilevel logistic regression model was employed to assess factors associated with the exclusive use of hygienic methods among reproductive-age women in Nepal. The model accounts for the hierarchical structure of the data, where women (Level 1) were nested within communities or clusters (Level 2). This approach allowed for the estimation of both fixed effects (individual-level and community-level predictors) and random effects (unobserved heterogeneity across communities). Intra-class correlation coefficients (ICCs) were calculated to quantify the proportion of the total variance attributable to differences between communities. The concentration Index (CI) and Concentration curve (CC) were also calculated to measure the socio-economic inequality of exclusive use of hygienic methods among reproductive-age women. Results Differentials in use of various types of menstrual products The distribution of various menstrual hygiene products according to age is represented in Table 1 . A total of seven methods have been reported to protect from bloodstains during menstruation. Disposable menstrual pads (59.8%) and cloth (47.6%) were the most commonly used across all age groups. However, a very small percentage of women used tampons and menstrual cups. Age-wise results show that over 75 percent of young women (15–24) used a disposable sanitary pad. About 59 percent of women in the older age group (35 years and above) use cloth to prevent menstruation. It is very surprising to report that still more than 10 percent of older age women (35 years and above) either used underwear to prevent bloodstains during menstruation or did not use anything. Table 1 Differentials in the use of various types of menstrual products among reproductive-age women, Nepal 2022 Type of menstruation products All women (Total) Age group 15–24 25–34 35 years and above Reusable Sanitary Pads a 1.1 1.3 1.0 0.9 Disposable Sanitary Pads a 59.8 75.8 59.2 41.6 Cloth b 47.6 36.5 49.7 58.8 Tampons a 0.1 0.1 0.2 0.0 Menstrual Cup a 0.1 0.1 0.1 0.1 Toilet Paper/Cotton Wool b 0.2 0.1 0.3 0.3 Underwear Only b 2.5 0.6 2.3 5.0 Nothing b 2.4 0.7 1.5 5.4 Note : Total percentage exceeds 100 due to multiple responses. A : Hygienic product, B : Unhygienic product Socio-demographic and economic characteristics of the study participants We evaluated the socio-demographic and economic characteristics of Nepalese women aged (15–49) as shown in Table 2 . Out of 13,065 reproductive-age women in Nepal, more than one-third (37.2%) were in the young (15–24 years) age group. The mean age of the women was 33.33 years, ranging from 15 to 49 years. Most women (65.5%) had their menarche between 13 and 15 years of age. About one-fourth of women were never married, while nearly one-third (33.4%) had less than 5 years of schooling. A majority of women (70%) were living in households that had improved sanitation facilities. In terms of restrictions on activities during the menstrual period, more than 50 percent of women reported facing restrictions on at least 1–2 activities during menstruation. More than half of women (52.1%) had exposure to mass media at least once a week, and 61.5% had personal smartphones. Only 16.5% of women were in white-collar jobs, while 27.9% of the women currently did not work. The majority of respondents (68.8%) lived in urban areas of the country. However, only 5.1% of the women lived in the mountain region, and more than 50% lived in the Terai region. At the community level, education (60.6%) and wealth are high (62.3%). Table 2 Weighted percentage distribution of reproductive-age women by background characteristics in Nepal, 2022 Background Characteristics N (13,065) Percentage (%) Individual-level variables Age of the women (in years) 15–24 4,858 37.2 25–34 4,086 31.3 35 years and above 4,122 31.5 Mean age (SD) 33.33 (7.65) Age at menarche (in years) 15 1,287 9.9 Do not remember 439 3.3 Marital status Never married 3,167 24.2 Married 9,898 75.8 Years of schooling < 5 4,366 33.4 5–9 4,216 32.3 10 years and above 4,483 34.3 Wealth index Poor 4,723 36.1 Middle 2,636 20.2 Rich 5,707 43.7 Religion Non-Hindu 2,166 16.6 Hindu 10,899 83.4 Type of home Marital home 6,531 50.0 Natal home 3,886 29.7 Head 2,648 20.3 Restrictions on activities during menstrual period No restriction 1,960 15.0 1–2 7,149 54.7 3–4 2,909 22.3 5+ 1,047 8.0 Households using improved sanitation facility No 4,330 33.1 Yes 8,735 66.9 Ecological region Mountain 665 5.1 Hill 5,294 40.5 Terai 7,106 54.4 Province Koshi 2,193 16.8 Madhesh 2,467 18.9 Bagmati 2,763 21.1 Gandaki 1,292 9.9 Lumbini 2,456 18.8 Karnali 781 6.0 Sudurpashchim 1,113 8.5 Residence Rural 4,081 31.2 Urban 8,985 68.8 Occupation of the woman Not working 3,650 27.9 White collar 2,151 16.5 Blue collar 7,264 55.6 Owns a smartphone No 5,032 38.5 Yes 8,033 61.5 Exposure to mass media (Newspaper/Radio/Television) Not at all 2,652 20.3 Less than once a week 3,605 27.6 At least once a week 6,809 52.1 Community-level variables Community Education Low 5,142 39.4 High 7,923 60.6 Community wealth Low 4,928 37.7 High 8,137 62.3 Community exposure to media Low 5,732 43.9 High 7,333 56.1 Note : N = sample size Exclusive use of hygienic methods by provinces of Nepal Figure 1 shows the distribution of women using the hygiene method for menstrual blood collection. Overall, 47.6% of women used hygienic methods. Exclusive use of hygienic methods varied across provinces of Nepal. Only 35.8% of women living in Karnali province exclusively used hygienic methods, while 59% of women residing in Bagmati and Gandaki provinces used hygienic methods only. Differentials in exclusive use of hygienic methods among reproductive-age women Table 3 shows the proportion of reproductive-age women using only hygienic methods based on background characteristics in Nepal. The exclusive use of hygienic methods was two times higher among young women (aged 15–24) (62.3%) than older women (35 years and above) (31.0%). Similarly, it was higher among women who had menarche before 13 years of age. It was also found that never-married women used more hygienic methods (71%) than ever-married women (40.1%). Moreover, the exclusive use of hygienic methods was three times higher among women with 10 years and above schooling (68.3%) than women with less than 5 years of education (23.8%). Women from affluent households had a higher proportion of exclusively used hygienic methods (65.3%) than women from poor families (29.8%). About one-third (32.4%) of women who faced multiple restrictions (more than five activities) on their daily activities during menstruation had a lower percentage of using hygienic methods. It was also found that women from rural areas (38.8%) used less hygienic methods than women from urban areas (51.5%). Similarly, the use of hygienic methods was lower among women residing in mountain regions (33.7%) compared to women living in hill (51.4%) or terai regions (46.0%), respectively. The exclusive use of hygienic methods was significantly higher among women who are currently not working (60.7%) and women working in white-collar jobs (70.5%) than women working in blue-collar jobs (34.1%). Women with exposure to mass media at least once a week exclusively used more hygienic methods (54%) than those without exposure to media (36.6%). In addition, women who owned smartphones had higher exclusively used hygienic methods (57.6%) than women who did not (31.6%). Table 3 Exclusive use of hygienic methods during menstruation among reproductive-age women by selected Background characteristics, Nepal 2022 Background characteristics Exclusively use hygienic methods (% weighted) Individual-level variables Age of the women (in years) p = 0.000 15–24 62.3 25–34 46.7 35 years and above 31.0 Age at menarche (in years) p = 0.000 15 37.1 Do not remember 31.4 Marital status p = 0.000 Never married 71.0 Married 40.1 Years of schooling p = 0.000 < 5 23.8 5–9 50.1 10 years and above 68.3 Wealth index p = 0.000 Poor 29.8 Middle 41.0 Rich 65.3 Religion p = 0.235 Non-Hindu 48.5 Hindu 47.4 Type of home p = 0.000 Marital home 39.5 Natal home 66.8 Head 39.1 Restrictions on activities during menstrual period p = 0.000 No restriction 49.0 1–2 49.3 3–4 47.7 5+ 32.4 Households using improved sanitation facility p = 0.045 No 45.2 Yes 48.7 Ecological region p = 0.000 Mountain 33.7 Hill 51.4 Terai 46.0 Province p = 0.000 Koshi 41.6 Madhesh 38.5 Bagmati 59.0 Gandaki 59.5 Lumbini 50.9 Karnali 35.8 Sudurpashchim 38.0 Residence p = 0.000 Rural 38.8 Urban 51.5 Occupation of the woman p = 0.000 Not working 60.7 White collar 70.5 Blue collar 34.1 Owns a smartphone p = 0.000 No 31.6 Yes 57.6 Exposure to any mass media (Newspaper/Radio/TV) p = 0.000 Not at all 36.6 Less than once a week 43.8 At least once a week 53.8 Community-level variables Community Education p = 0.000 Low 35.8 High 55.2 Community wealth p = 0.000 Low 33.5 High 56.1 Community exposure to media p = 0.000 Low 43.9 High 50.4 Variance estimates across communities and intra-class correlation coefficients (ICCs) A model applied without covariates (called the null model) on the exclusive use of hygienic methods among reproductive-age women (Table 4 ) showed significant variation in the exclusive use of hygienic methods communities. Based on intra-class correlation coefficient (ICC) values, 16.6% of the total variance in using hygienic methods was attributable to differences across communities. After including individual variables (Model 1) in the null model, the ICC values decreased to 9.2% (community level). Table 4 Variance estimates across communities and intra-class correlation coefficients (ICCs) for the multilevel models for exclusive use of hygienic methods among reproductive-age women Model Community (PSU) Variance (95% CI) ICC (95% CI) Null model 0.653 (0.548, 0.777) 16.6 (14.3, 19.1) Adjusted model (Model 1) 0.335 (0.269, 0.418) 9.2 (7.6, 11.3) Results of the multilevel logistic regression model The determinants of the exclusive use of hygienic methods were examined using a multilevel logistic regression model. Results of the multilevel model show that young women aged 15–24 years (AOR = 2.51, CI: 2.18–2.89) were 2.5 times and women aged 25–34 (AOR = 1.69, CI: 1.50–1.90) were 1.69 times more likely to exclusively use hygienic methods than women aged 35 years and higher. The odds of exclusive use of hygienic methods in women were 44% higher among never-married women (AOR = 1.44, CI: 1.21–1.72) than their married counterparts. Women with 10 years and above of schooling (AOR = 1.98, CI: 1.73–2.27) were 98%, and women with 5–9 years of schooling (AOR = 1.80, CI: 1.60–2.02) were 80% more likely to use hygienic methods than women with less than 5 years of schooling. The odds of exclusive use of hygienic methods were 2.16 times higher among women in rich households (AOR = 2.16, CI: 1.87–2.49). Restrictions on women during their menstruation period were negatively associated with the use of hygienic methods. Women with no restrictions (AOR = 1.42, CI: 1.18–1.71) were 42% more likely to use hygienic methods than women with five or more restrictions on activities, respectively. The odds of exclusive use of hygienic methods varied significantly by the occupational status of the woman. Regarding women working in blue-collar jobs, exclusive hygienic methods were used twice among women in white-collar jobs (AOR = 2.14, CI: 1.87–2.45). The chances of exclusive use of hygienic methods were 41% higher among women who owned a smartphone than those who did not (AOR = 1.41, CI: 1.28–1.56). In addition, women exposed to mass media at least once a week were 36% more likely to use hygienic methods than women without exposure to mass media (AOR = 1.36, CI: 1.20–1.54). At the community level, higher community wealth was positively associated with the exclusive use of hygienic methods during menstruation. Table 5 Multilevel logistic regression analysis assessing the effect of background characteristics on the exclusive use of hygienic methods among reproductive age women in Nepal, 2022 Background Characteristics Adjusted odds ratio p-value 95% CI Lower Upper Individual-level variables Age of the women (in years) 15–24 2.51 0.000 2.18 2.89 25–34 1.69 0.000 1.5 1.9 35+ 1 Age at menarche (in years) 15 1 Don’t know 1 0.977 0.75 1.33 Marital status Never married 1.44 0.000 1.21 1.72 Married 1 Years of schooling < 5 1 05- 1.8 0.000 1.6 2.02 10+ 1.98 0.000 1.73 2.27 Wealth index Poor 1 Middle 1.4 0.000 1.23 1.59 Rich 2.16 0.000 1.87 2.49 Type of home Marital home 1 Natal home 1.48 0.000 1.26 1.73 Head 1.08 0.18 0.96 1.21 Restrictions on activities during menstrual period No restriction 1.42 0.000 1.18 1.71 1–2 1.52 0.000 1.3 1.77 3–4 1.3 0.001 1.11 1.52 5+ 1 Households using improved sanitation facility No 1 Yes 1.12 0.017 1.02 1.23 Ecological region Mountain 1 Hill 0.84 0.196 0.65 1.09 Terai 0.7 0.009 0.53 0.91 Residence Rural 1 Urban 0.96 0.544 0.82 1.11 Occupation of the woman Not working 1.4 0.000 1.25 1.56 White collar 2.14 0.000 1.87 2.45 Blue collar 1 Owns a smartphone No 1 Yes 1.41 0.000 1.28 1.56 Exposure to mass media (Newspaper/Radio/Television) Not at all 1 Less than once a week 1.04 0.53 0.91 1.19 At least once a week 1.36 0.000 1.2 1.54 Community-level variables Community Education Low 1 High 1.02 0.81 0.87 1.2 Community wealth Low 1 High 1.7 0.000 1.4 2.07 Community exposure to media Low 1 High 0.87 0.065 0.75 1.01 Figure 2 shows the concentration curve for the exclusive use of hygienic methods among reproductive-age women in Nepal. The concentration curve (CC) lies below the line of equality; it implies that the exclusive use of hygienic methods among women is concentrated among the rich. Moreover, if CC were formed above the line of equality, the inequality would concentrate on the poor and vice-versa. Additionally, the more areas between the line of equality and the curve, the higher the inequality. Nepal had an inequality of 0.21, which describes that exclusive use of hygienic methods was concentrated among rich women. Among the geographical regions of Nepal, the highest inequality was witnessed in Madhesh province (0.25), followed by Bagmati province (0.22). The lowest inequality was observed in Sudurpashchim province (0.08), followed by Karnali province (0.11). In all the provinces of Nepal, the exclusive use of hygienic methods is concentrated among rich women only. Figure 3 presents the restrictions faced by women during their menstruation period in Nepal by province for each activity. In Nepal, about 65% of women were not allowed to enter the temple or to get involved in religious activities, and one-third of women were also not allowed to touch or cook food during menstruation. In addition, 14.3% of women were restricted even from fetching water to plants. Discussion The current study aimed to evaluate the factors influencing exclusive use of hygienic methods during menstruation among reproductive-age women in Nepal. Using nationally representative recent data from Nepal, this study is one of the first studies to highlight various socio-demographic predictors of exclusive use of hygienic methods during the menstruation period in Nepal. Our study shows that only 48% of reproductive-age women exclusively used the hygienic method during menstruation. However, 39% of women reported that they are still using unhygienic menstrual absorbents such as old clothes, rags, or other unclean menstruation absorbents. The exclusive use of hygienic methods was seen to be higher than the studies conducted in Pakistan (25%) [ 20 ], Ethiopia (46.4%) [ 21 ] and sub-Saharan Africa (45%) [ 22 ]. Contrary to the findings of this study, a higher prevalence (50–70%) of using hygienic method was obtained in a similar study conducted in India [ 23 , 24 ]. The possible explanation for discrepancies is mainly due to socioeconomic and cultural differences between countries that directly affect menstrual hygiene practices. Furthermore, it can be due to the difference in implementing programs and schemes at school and community level on menstruation hygiene management. The present study identified several important individual, household, and community-level factors significantly associated with hygienic menstrual practices. The analysis also indicated a significant difference in the use of exclusive menstrual hygiene practices across Nepal's provinces and ecological levels. In this study, multivariable analysis showed that young women (15–24 years of age) with higher years of schooling, never-married women, women who belonged to the richest wealth quintiles, no restrictions on activities during the menstrual period, owned smartphone, exposed to mass media at least once a week, worked into a white-collar job, and higher community wealth were significantly higher usage of menstrual hygiene product than their counterpart. The odds of exclusive use of hygienic methods decreased with the increase in age of women. We found that exclusive use of hygienic methods was significantly higher among younger women (15–24) than their older counterparts (aged 35 and above). This finding corroborates a previous study in Nepal that analyzed adolescent girl practicing more hygienic methods (67%) during the mensuration period than their counterpart [ 3 ]. This finding also aligns with the study from India and Bangladesh [ 11 , 23 , 25 ]. This result implies that younger women are more aware and serious regarding the importance of hygienic methods during menstruation. In recent years, the Nepalese government and other non-governmental organizations (NGOs), specifically UNICEF, have promoted the WASH for Schools (WinS) program and provided menstrual management facilities in schools to encourage hygienic and safe menstruation habits among adolescent girls. As a result, it has positively impacted knowledge and practices of hygiene menstruation among young women [ 26 , 27 ]. This study also highlighted that the exclusive use of hygienic methods was more prevalent among never-married women than married women. Similar results were reported from another study conducted in India that found exclusive hygienic methods were relatively higher among unmarried women (71.0%) than married women [ 11 ]. A possible explanation for these similarities may be that most of the unmarried women enrolled in school or colleges have more opportunities to obtain relevant information about menstrual hygiene and safe hygiene practicing during menstruation than those who are married and have less exposure to getting information. The present study also demonstrated that increased educational years was significantly associated with a decrease in poor menstrual hygiene practices. We found that women who had ten years and above educational levels had more chances of using an appropriate menstrual practice than women with less than < 5 years of schooling. This finding is in line with previous studies conducted in Nepal and other countries [ 6 , 11 , 23 , 25 ]. These studies consistently show that women with a higher level of education understand the benefits of using hygienic methods and are more aware of the risks associated with unhygienic menstruation practices. The exclusive use of hygienic menstrual practices is also significantly associated with the household's wealth status. Previous studies have documented that the prevalence of exclusive hygienic method is relatively low among women belonging to poor families [ 10 , 11 , 20 ]. Our results confirm the same and indicate that women who belonged to affluent families used twice the exclusive use of hygienic methods as poor women. The results from the concentration curve also demonstrated that the exclusive use of hygiene methods among women is concentrated in women from higher economic backgrounds. This is probably because women from lower income households are unable to seek higher education and are not able to afford sanitary products, which results in poor menstrual practices [ 10 ]. Another important finding of this study is that women who faced any menstrual restrictions, such as not allowed to enter the temple or get involved in religious activities, or women were also not allowed to touch or cook in the kitchen, are more likely to practice unhygienic menstruation methods than those who did not face any menstrual restriction. It is also reflected in our results that 85% of Nepalese women experience some sort of menstrual restriction. This result is consistent with a study in Nepal, which mentioned that due to social and individual restrictions against women when menstruating there are significant changes have been observed in menstrual practices [ 28 ]. Our findings highlighted deeply rooted menstruation-related socio-cultural and religious restrictions that continue to affect menstrual hygiene practices among Nepalese women. Unfortunately, these restrictions are still widespread and often overlooked by the society [ 2 ]. Regarding the province-based distribution of exclusive use of menstrual hygiene practices, we found geographical heterogeneity across Nepal, with Madhesh province and Bagmati province having the highest inequality of 0.25 and 0.22 during the study period. Alternatively, two northern provinces, Karnali and Sudurpashchim, showed comparatively good menstruation practices. Another significant finding of this study was the positive role of women’s exposure to mass media on menstrual hygiene practices. The finding of this study revealed that exposure to mass media at least once a week is significantly associated with exclusive use of hygienic methods. The finding was congruent with a study conducted on school adolescents in Nepal reported that 70% of the girls received information on menstruation from the local radio station [ 13 ]. Many previous studies suggest that exposure to diverse mass media can play a prominent role in disseminating information, including menstruation and menstrual hygiene-related topics [ 11 , 29 ]. Our study also found that the ownership of smartphones was significantly associated with higher use of hygienic methods during menstruation. This finding is consistent with earlier studies conducted in India and Bangladesh [ 11 , 25 ]. The finding indicates that access to mobile phones is important in addressing awareness among women on menstruation practices as mobile phones provide easy access to information. Also, information on menstruation through various media and digital awareness among women reduces societal stigma on menstruation and promotes the safe and hygienic menstruation practice [ 4 ]. Strength and Limitations The present study exhibits several notable strengths. This is the first study on this topic at the national level that assesses the exclusive use of mensuration hygienic methods among Nepalese women. Moreover, the data quality and large sample size ensure the generalization of the findings. Secondly, the study identified potential determinants that are significantly associated with hygienic menstruation practices. The study's outcome will be important information for Nepal government and public health practitioners to design a programmatic set of actions to address the menstruation problems in the country. Moreover, this study provides further direction for future research to explore and enable appropriate solutions to hygiene menstrual practices. Nevertheless, our study has some limitations. The study's cross-sectional nature makes it difficult to build causal relationships between the outcome and exposure variables. The reliance on self-reported nature of the data can be subject to recall bias and social desirability bias. Also, due to the unavailability of data, we were unable to investigate the association between knowledge and awareness of women on mensuration hygiene practices. Conclusions The study shows that less than half of the women are using hygienic menstrual practices. The findings suggest the need for multidimensional interventions and educational programs targeting socio-economically vulnerable women to address unhygienic menstrual practices. More research is needed to determine the effect of social norms, stigma, and restrictions on menstruation hygiene practices. Also, a special focus on providing poor households and communities with subsidized or free menstrual hygiene products can reduce the disparities. Engagement of digital media in advocating for menstruation management can help raise awareness throughout society. There is a need for a strategic approach to combating the myths and social taboos associated with menstruation to improve the practices of exclusive use of hygienic menstruation. Also, there is a need to educate adult women on biological facts and good hygienic practices, as they can impose cultural taboos and restrictions on the next generation. Findings recommend multidimensional interventions and educational programs needed for socioeconomically vulnerable women to address unhygienic menstrual practices. Declarations Ethical approval and consent to participate This study is based on secondary data which is available in public domain. Therefore, ethical approval is not required for conducting this study. Consent for publication Not applicable Availability of data and materials The data that support the findings of this study are available on request from the corresponding author. Competing interests The authors declare that they have no competing interests in this section. Funding details The author(s) received no financial support for the research, authorship, and/or publication of this article. Authors' contributions All author has made substantial contributions to the conception and design of the work. P.K. analysis the data, P.K and N.H. interpretation of data, P.K and N.H. prepared tables 1-5, N.H and R.R. prepared figures 1-3, R.R. wrote the first draft of the main manuscript. PK and RR reviewed and finalized the manuscript for publication . Acknowledgment The authors wish to thank Raghu Varma, an independent researcher from Lucknow, India, for his invaluable assistance in English editing this manuscript. References WHO/UNICEF. Guidance on Menstrual Health and Hygiene. 2019 [Internet]. Available from: https://www.unicef.org/media/91341/file/UNICEF-Guidance-menstrual-health-hygiene-2019.pdf Mukherjee A, Lama M, Khakurel U, Jha AN, Ajose F, Acharya S, et al. Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey. Reprod Health. 2020 Dec;17(1):81. Bhusal CK. Practice of Menstrual Hygiene and Associated Factors among Adolescent School Girls in Dang District, Nepal. Adv Prev Med. 2020 Jul 24; 2020:1–7. Sharma A, McCall-Hosenfeld JS, Cuffee Y. Systematic review of menstrual health and hygiene in Nepal employing a social ecological model. Reprod Health. 2022 Dec;19(1):154. World Bank Group. Menstrual Health and Hygiene. 2022. Available at: https://www.worldbank.org/en/topic/water/brief/menstrual-health-and-hygiene#:~:text=Menstrual%20Health%20and%20Hygiene%20(MHH,menstrual%20hygiene%20management%20(MHM). Accessed on June 23, 2024. Khanal G, Shrestha N, Adhikari K, Ghimire U. Menstruation hygiene management among secondary school students of Chitwan, Nepal: a cross-sectional study. BMC Womens Health. 2023 Jul 26;23(1):395. Ministry of Health and Population [Nepal], New ERA, and ICF. Kathmandu, Nepal: Ministry of Health and Population [Nepal]. Nepal Demographic and Health Survey 2022. Available at: https://dhsprogram.com/pubs/pdf/FR379/FR379.pdf Accessed on June 6, 2024. UNICEF and WaterAid South Asia Regional Team. Menstrual Hygiene in Schools in South Asia: Synthesis Report. 2021. Available at: https://washmatters.wateraid.org/sites/g/files/jkxoof256/files/menstrual-hygiene-management-in-schools-in-south-asia---synthesis-report.pdf Accessed on June 7, 2024. Basyal S. How Menstruation is shaping Girls’ Education in Rural Nepal. 2016. e Journal of Education Policy. Available at: https://files.eric.ed.gov/fulltext/EJ1158204.pdf Accessed on July 1, 2024. Sapkota A, Karn VL, Chand S, Shastry CS, Pant BD. Knowledge and Practice of Menstrual Hygiene among Adolescent Girls inPanauti Municipality, Kavrepalanchowk, Nepal: A Study from Low Middle-income Country. Curr Women Health Rev. 2022 May;18(2): e041021192819. Singh A, Chakrabarty M, Singh S, Chandra R, Chowdhury S, Singh A. Menstrual hygiene practices among adolescent women in rural India: a cross-sectional study. BMC Public Health. 2022 Nov 19;22(1):2126. Shanta Upadhya & Anup Adhikari. Menstruation Hygiene Practices Among Girl Students in Kathmandu Valley. 89 Pragyaratna, Vol: 5, Issue: 1, 2023. ISSN: 977-2565-5000-04 Yadav, Joshi. Knowledge, Attitude, and Practice on Menstrual Hygiene Management among School Adolescents. JNHRC Vol. 15 No. 3 Issue 37, 212-216 YUWA. Menstrual Hygiene Management in Nepal. 2018 [Internet]. Available from: https://www.asiapacificalliance.org/application/files/7415/5963/8758/YUWA_Menstrual_Hygiene_Management_in_Nepal__2018.pdf Accessed on June 4, 2024. UNICEF. Menstrual health and hygiene management still out of reach for many. 2022 [Internet]. Available from: https://www.unicef.org/press-releases/fact-sheet-menstrual-health-and-hygiene-management-still-out-reach-many Accessed on June 13, 2024. Cardoso LF, Clark CJ, Rivers K, Ferguson G, Shrestha B, Gupta J. Menstrual restriction prevalence and association with intimate partner violence among Nepali women. BMJ Sex Reprod Health. 2019 Jan;45(1):38–43. Kumar R, Maity B. Cultural norms and women’s health: Implications of the practice of menstrual restrictions in Nepal. World Dev Perspect. 2022 Sep; 27:100450. Thakuri DS, Thapa RK, Singh S, Khanal GN, Khatri RB. A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication. Federici S, editor. PLOS ONE. 2021 Sep 1;16(9): e0256968. Thapa S, Aro AR. ‘Menstruation means impurity’: multilevel interventions are needed to break the menstrual taboo in Nepal. BMC Womens Health. 2021 Dec;21(1):84. Wasan Y, Baxter JAB, Rizvi A, Shaheen F, Junejo Q, Abro MA, et al. Practices and predictors of menstrual hygiene management material use among adolescent and young women in rural Pakistan: A cross-sectional assessment. J Glob Health. 2022 Aug 10; 12:04059. Ahmed Shallo S, Willi W, Abubeker A. Factors Affecting Menstrual Hygiene Management Practice Among School Adolescents in Ambo, Western Ethiopia, 2018: A Cross-Sectional Mixed-Method Study. Risk Manag Healthc Policy. 2020 Sep; Volume 13:1579–87. Anbesu EW, Asgedom DK. Menstrual hygiene practice and associated factors among adolescent girls in sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health. 2023 Jan 6;23(1):33. Meher T, Sahoo H. Dynamics of usage of menstrual hygiene and unhygienic methods among young women in India: a spatial analysis. BMC Womens Health. 2023 Nov 6;23(1):573. Roy A, Paul P, Saha J, Barman B, Kapasia N, Chouhan P. Prevalence and correlates of menstrual hygiene practices among young currently married women aged 15–24 years: an analysis from a nationally representative survey of India. Eur J Contracept Reprod Health Care. 2021 Jan 2;26(1):1–10. Afiaz A, Biswas RK. Awareness on menstrual hygiene management in Bangladesh and the possibilities of media interventions: using a nationwide cross-sectional survey. BMJ Open. 2021 Apr;11(4): e042134. Shrestha S, Shrestha S, Ito Y, Kobayashi Y, Nishida K, Futaba K, et al. Situation of menstrual management facilities in schools of peri-urban areas of Nepal: WASH, privacy, and healthcare. J Water Sanit Hyg Dev. 2022 Jan 1;12(1):41–51. Dhakal. Analysis of menstrual hygiene practices in Nepal: the role of WASH in Schools programme for girls’ education. 2018. 41st WEDC International Conference, Egerton University, Nakuru, Kenya, 2018. Paper 2870 Available at: https://wedc-knowledge.lboro.ac.uk/resources/conference/41/Dhakal-2870.pdf Accessed on July 2, 2024. Madhusudan Subedi, Sara Parker. Menstrual Exclusions in Nepal: Some Evidence of Transition. Dhaulagiri Journal of Sociology and Anthropology Vol. 15, 2021, pp. 1-9. Available at: https://www.nepjol.info/index.php/DSAJ/article/view/41921 Accessed on July 6, 2024. Upashe SP, Tekelab T, Mekonnen J. Assessment of knowledge and practice of menstrual hygiene among high school girls in Western Ethiopia. BMC Womens Health. 2015 Dec;15(1):84. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 12 Mar, 2025 Read the published version in Reproductive Health → Version 1 posted Editorial decision: Revision requested 08 Dec, 2024 Reviews received at journal 08 Dec, 2024 Reviews received at journal 03 Dec, 2024 Reviewers agreed at journal 25 Nov, 2024 Reviewers agreed at journal 23 Nov, 2024 Reviews received at journal 23 Nov, 2024 Reviewers agreed at journal 09 Nov, 2024 Reviewers invited by journal 01 Nov, 2024 Editor assigned by journal 18 Oct, 2024 Submission checks completed at journal 18 Oct, 2024 First submitted to journal 18 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5286445","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":367661713,"identity":"fc4e2a1d-f6cf-40bf-81a3-15d9a356e61d","order_by":0,"name":"Nihal Hasan","email":"","orcid":"","institution":"International Institute for Population Sciences","correspondingAuthor":false,"prefix":"","firstName":"Nihal","middleName":"","lastName":"Hasan","suffix":""},{"id":367661714,"identity":"0d17499e-5c76-47b8-8ad9-c4dffd328523","order_by":1,"name":"Pradeep Kumar","email":"","orcid":"","institution":"International Institute for Population Sciences","correspondingAuthor":false,"prefix":"","firstName":"Pradeep","middleName":"","lastName":"Kumar","suffix":""},{"id":367661715,"identity":"cd05a378-8b2e-472a-8e29-f29edcc081ea","order_by":2,"name":"Rahul Rajak","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYHCCBAbGBgYZNvbGxgcfgFw2diK18PDzHD5sOAOkhZkYe0BaJGekpQnzgHiEtJi3H3j24eeOwzwGN3LMmG1+bZPnY2Zg/PAxB7cWmTMJyTN7zwC1nHlj9ji377ZhGzMDs+TMbbi1SDAkJDPwtgG1HM8xN87tuc0I1MLGzItPC/+DZMa/IC0HcsykLXtu2xPWIpGQzAyyRbIjLU2a4cftRCK0PEhmlm1LhwRyb8Pt5DZmxmb8fuHPSWZ822YtB47KH39u285vbz744SMeLQwMPAkINmMbmGzApx4I2A8gcf4QUDwKRsEoGAUjEgAAxTpRGNYuiboAAAAASUVORK5CYII=","orcid":"","institution":"Institute of Development Studies Kolkata","correspondingAuthor":true,"prefix":"","firstName":"Rahul","middleName":"","lastName":"Rajak","suffix":""}],"badges":[],"createdAt":"2024-10-18 04:53:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5286445/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5286445/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12978-025-01976-5","type":"published","date":"2025-03-12T15:58:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67084613,"identity":"30a8c05c-c51a-47d5-b611-0be1032291ce","added_by":"auto","created_at":"2024-10-21 05:40:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":124179,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eExclusive use of hygienic methods in different province of Nepal, 2022\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5286445/v1/7003280792aeb21892b54e9f.png"},{"id":67085679,"identity":"58e5c448-66f3-4d54-b423-932f80092bea","added_by":"auto","created_at":"2024-10-21 05:56:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38885,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSocio-economic inequality in exclusive use of hygienic methods by provinces of Nepal, 2022\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5286445/v1/05799abca50d68773ed45bdc.png"},{"id":67084615,"identity":"70f97116-f892-48e8-a7ca-a0eb938b3a5c","added_by":"auto","created_at":"2024-10-21 05:40:46","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":30780,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRestrictions on women’s daily activities during menstruation period by the province of Nepal\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5286445/v1/64414b38b56eac6ae7f5da38.png"},{"id":78689097,"identity":"a9f78115-5258-4ebd-b10e-4821a34834d3","added_by":"auto","created_at":"2025-03-17 16:11:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2454655,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5286445/v1/2354e6a0-89d0-41fa-9a1e-e84ab8382165.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Drivers of Hygienic Menstrual Practices among Reproductive-Age Women: Evidence from Nepal Demographic Health Survey-2022","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMenstruation is a natural and biological process that every woman experiences throughout her reproductive years. Maintaining menstrual hygiene is a process in which \u003cem\u003e\u0026ldquo;women and adolescent girls use a clean menstrual management material to absorb and collect blood, that can be changed in privacy as often as necessary for the duration of the period, using soap and water for washing the body as required and having access to facilities to dispose of used menstrual management materials\u0026rdquo;\u003c/em\u003e [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, in Nepal, menstruation is perceived as a taboo, stigma, and uncomfortable topic, and people are ashamed of the disclosure of their menarche [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Due to poor knowledge and awareness about menstrual hygiene, women face significant challenges in managing menstruation hygienically [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. To ensure menstruation hygienically and with dignity, menstrual hygiene management (MHM) has received particular attention from Sustainable Development Goals 6.1 and 6.2, which aim for the \u0026lsquo;access to adequate and equitable sanitation and hygiene for all\u0026rsquo;, paying particular attention to the needs of women and girls.\u003c/p\u003e \u003cp\u003eIt is estimated that worldwide, 500\u0026nbsp;million women lack access to menstrual products and adequate facilities for MHM [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. According to a recent study in Nepal, every day, approximately 2,90,000 women and girls experience menstruation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, around 39% of women still not use an appropriate material during their last menstruation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. To recognize the importance of promoting menstruation hygiene practices, in the year of 2020, Government of Nepal (GoN) introduced a national sanitary pad (distribution and management) procedure to distribute free sanitary pads to government-aided schools [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite GoN efforts, there is still a significant portion of women who are incapable of achieving exclusive use of hygienic methods of menstruation practices. A systematic review-based study explained that Nepal's socio-demographic and cultural features lead to unhygienic menstrual practices, such as use of unhygienic menstrual products, lack of information about menstruation hygiene, and access to safe water and clean toilets [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Moreover, previous studies conducted on Nepalese women reported that an unhygienic sanitation practice during menstruation exposes women to risks of various urogenital infections, including reproductive tract infections (RTIs) and urinary tract infections (UTIs) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Unhygienic menstrual practices are also associated with compromising women's educational and economic opportunities and resulting in a diminished quality of life [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, the exclusive use of hygienic methods during menstruation is a major public health and social issue in Nepal.\u003c/p\u003e \u003cp\u003eNumerous studies reported that exclusive use of menstrual hygiene methods is influenced by a variety of factors, including age, age at menarche, educational status, marital status, wealth status, place of residence, source of water, toilet facility, and media exposure, etc [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. For instance, the level of knowledge regarding menstrual hygiene management, such as use of sanitary pads, frequency in changing pads, bathing and cleaning genital areas during menstruation, and appropriate disposal of used sanitary pads, is significantly associated with age and place of residence [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Studies have revealed that urban women and girls have more access to sanitary pads as compared to their rural counterparts [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Evidence shows that only 9% of women from rural Nepal use sanitary pads, while 89% still use cloth during menstruation. Meanwhile, in urban areas, 34% of women use sanitary pads, and 64% use clothing during their periods [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn many parts of Nepal, menstrual practices are deeply influenced by social and cultural norms. According to UNICEF, more than two-thirds of women in Nepal did not participate in regular activities while menstruating [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A study conducted in three districts within the Terai region in Nepal explained that three out of four women experienced two or more types of menstrual restriction [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Also, cultural customs like \u0026lsquo;Chhaupadi\u0026rsquo; (\u003cem\u003ea custom in which women and girls are banished to isolated huts or sheds and experience grossly unhygienic conditions while menstruating\u003c/em\u003e) exacerbate unhygienic menstrual management as highlighted by many studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although this practice was declared illegal by Nepal\u0026rsquo;s Supreme Court in May 2005 and was criminalized under the Criminal Code Act (2017), the practice still exists in some areas and communities in Nepal [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Nepal, most studies on mensuration hygiene particularly focused on adolescent girls and were centered on rural communities or specific geographical areas [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Very limited studies have investigated the national level and examined the factors associated with hygiene menstruation practices in reproductive-age women. To our knowledge, no study has been conducted in Nepal that has examined the prevalence of exclusive use of hygienic methods among women (15\u0026ndash;49 years) using nationally representative data. To fill this gap, the present study hypothesized that the exclusive use of menstrual hygiene practices was positively associated with socio-demographic, socio-cultural, economic, and factors related to the ecological and provincial distribution of Nepal. Thus, the present study aims to assess the factors influencing the exclusive use of hygienic methods during menstruation among reproductive-age women in Nepal.\u003c/p\u003e"},{"header":"Data and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData\u003c/h2\u003e \u003cp\u003eThe study utilized data from the 2022 Nepal Demographic and Health Survey (NDHS), conducted between January 5 - June 22, 2022. The survey collected information on fertility, marriage, family planning, breastfeeding practices, nutrition, food insecurity, maternal and child health, childhood mortality, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), women\u0026rsquo;s empowerment, domestic violence, fistula, mental health, accident and injury, disability, and other health-related issues such as smoking, knowledge of tuberculosis, and prevalence of hypertension.\u003c/p\u003e \u003cp\u003eNepal Demographic and Health Survey (NDHS) used a sampling frame from an updated version of the 2011 Nepal Population and Housing Census (NPHC) provided by the National Statistical Office. The NDHS-2022 considered wards from the 2011 census as sub-wards, the smallest administrative unit for the survey. The survey used a stratified sample that was selected in two stages. Stratification was done by dividing each of the seven provinces into urban and rural areas, which together formed the sampling stratum for that province. A total of 14 sampling strata were created in this way. In the first sampling stage, 476 primary sampling units (PSUs) were selected with probability proportional to PSU size and with independent selection in each sampling stratum within the sample allocation. Among the 476 PSUs, 248 were from urban areas and 228 from rural areas. Detailed sampling design and data collection procedure are given elsewhere [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A total of 13,786 households, 14,845 women and 4,913 men aged 15\u0026ndash;49 years, were successfully interviewed, with a response rate of 99.7%, 97.4%, and 94.8%, respectively. The final sample size of this study was 13065 women aged 15\u0026ndash;49 years.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcome variable\u003c/h3\u003e\n\u003cp\u003eNDHS-2022 asked a multiple-response question to eligible female respondents about the specified materials used to collect or absorb blood from the most recent menstrual period during their menstruation to prevent blood stains from becoming evident. Response options included ten categories: i) reusable sanitary pads, ii) disposable sanitary pads, iii) tampons, iv) menstrual cups, v) cloth, vi) toilet paper, vii) cotton wool, viii) underwear only, ix) other, and x) nothing. The first four and vi, vii of these are labelled as hygienic methods, and the remaining as unhygienic. The outcome variable of this study is \u0026ldquo;exclusive use of hygienic methods\u0026rdquo;. A woman is considered \u0026ldquo;an exclusive user of hygienic methods\u0026rdquo; if she uses hygienic methods only. Any woman who uses either unhygienic methods or a combination of hygienic and unhygienic methods is considered \u0026ldquo;not an exclusive user of hygienic methods\u0026rdquo;.\u003c/p\u003e\n\u003ch3\u003ePredictor variables\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eRespondent\u0026rsquo;s age collected at the time of the survey was classified into three groups: \u0026ldquo;15\u0026ndash; 24\u0026nbsp;years\u0026rdquo;, \u0026ldquo;25\u0026ndash;34\u0026nbsp;years, and \u0026ldquo;35\u003c/em\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eyears\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at menarche\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAge at menarche were grouped into following categories - \u0026lsquo;less than 13 years\u0026rsquo;, \u0026lsquo;13\u0026ndash;15 years\u0026rsquo;, \u0026lsquo;more than 15 years\u0026rsquo;, and \u0026ldquo;Don\u0026rsquo;t know\u0026rdquo; (for women who do not remember the age.)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eThe survey collected the current marital status as follows: 0 \u0026ldquo;Never in union,\u0026rdquo; 1 \u0026ldquo;married,\u0026rdquo; 2 \u0026ldquo;living with a partner,\u0026rdquo; 3 \u0026ldquo;widowed,\u0026rdquo; 4 \u0026ldquo;divorced,\u0026rdquo; and 5 \u0026ldquo;no longer living together/separated.\u0026rdquo; However, for this study, we grouped it into two categories: (0) \u0026ldquo;Never married\u0026rdquo; and (1,2,3,4,5) \u0026ldquo;Ever married\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of schooling\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eEducation in single years of schooling was recoded into the following categories: \u0026ldquo;\u0026lt; 5 years\u0026rdquo;, \u0026ldquo;5\u0026ndash;9 years\u0026rdquo;, and \u0026ldquo;10\u0026thinsp;+\u0026thinsp;years\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth index\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eWealth quintile variable was recoded into three categories: \u0026ldquo;Poor,\u0026rdquo; \u0026ldquo;Middle,\u0026rdquo; and \u0026ldquo;Rich.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eReligion was recorded as \u0026ldquo;Hindu\u0026rdquo; and \u0026ldquo;Non-Hindu\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of home\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eType of home is created based on the respondent\u0026rsquo;s relationship with the household head; three categories were created, \u0026minus; marital home, natal home, and household head. \u0026lsquo;Marital home\u0026rsquo; (1) includes wife, daughter-in-law, mother, mother-in-law, co-spouse, sister-in-law; \u0026lsquo;natal home\u0026rsquo; (2) includes daughter, granddaughter, sister, other relative, adopted/foster child, not relative, niece by blood; \u0026lsquo;Head\u0026rsquo; (3) respondents who are household head themselves [Ref.]\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRestrictions on activities during menstrual period\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eRespondents reported the activities they are excluded from during the menstrual period, like entering the temple, getting involved in religious activities, touching or cooking food, eating with family members, staying in the main house, touching plants, touching other people, touching cattle, fetching water, sleep with husband, and other. A variable was created- the number of activities respondents were excluded from then recoded into four categories- 0 No restriction, 1\u0026ndash;2 restrictions, 3\u0026ndash;4 restrictions, and 5\u0026thinsp;+\u0026thinsp;restrictions.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHouseholds using improved sanitation facility\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eHouseholds that were using improved sanitation facilities without sharing it with any other household were recorded as \u0026ldquo;Yes,\u0026rdquo; otherwise, \u0026ldquo;No.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eImproved sanitation facility includes toilets of the following types: flush to piped sewer systems, septic tanks, pit latrines, or an unknown destination; ventilated improved pit (VIP; pit latrines with slabs; and composting toilets.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEcological region\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eNepal is classified into three ecological regions- Mountain, Hill, and Terai.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProvince\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eThe 7 provinces of Nepal are Koshi, Madhesh, Bagmati, Gandaki, Lumbini, Karnali, and Sudurpashchim.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eResidence was categorized into two groups: \u0026ldquo;Urban\u0026rdquo; and \u0026ldquo;Rural\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDescription\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation of the woman\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eRespondent\u0026rsquo;s occupation was grouped into three categories: 1 \u0026ldquo;Not working\u0026rdquo;; 2 \u0026ldquo;White collar\u0026rdquo; includes professional/technical/managerial, clerical, and sales; 3 \u0026ldquo;Blue collar\u0026rdquo; includes agricultural-self-employed, skilled manual, unskilled manual, and others.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOwned smartphone\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eWhether a respondent owns a smartphone by herself. Recorded as \u0026ldquo;Yes\u0026rdquo; and \u0026ldquo;No\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExposure to any mass media\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eRespondents were asked how often they read newspapers or magazines, listen to the radio, and watch television in three different variables in the following categories: 0 \u0026ldquo;Not at all,\u0026rdquo; 1 \u0026ldquo;Less than once a week,\u0026rdquo; and 2 \u0026ldquo;At least once a week.\u0026rdquo; In this study, we combined all three sources to create exposure to any mass media (Newspapers or magazines/ Radio/ Television).\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity education\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCommunities were grouped into two groups based on the proportion of women with less than 5 years of schooling in PSUs. 1 \u0026ldquo;High\u0026rdquo; if the proportion was less than the national average and 2 \u0026ldquo;Low\u0026rdquo; otherwise.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity wealth\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCommunities were grouped into two groups based on the proportion of poor women in PSUs. 1 \u0026ldquo;High\u0026rdquo; if proportion was less than the 25th percentile and 2 \u0026ldquo;Low\u0026rdquo; otherwise.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity exposure to media\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCommunities were grouped into two groups based on the proportion of women exposed to mass media at least once a week in PSUs. 1 \u0026ldquo;High\u0026rdquo; if proportion was more than the 75th percentile and 2 \u0026ldquo;Low\u0026rdquo; otherwise\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe analysis of this study is based on reproductive-age women (aged 15\u0026ndash;49 years) in Nepal sampled in the NDHS-2022. The study used bivariate analysis to examine the association between the exclusive use of hygienic methods and other socio-demographic predictors. The chi-square test was applied to observe the significant association between them. Further, a multilevel logistic regression model was employed to assess factors associated with the exclusive use of hygienic methods among reproductive-age women in Nepal. The model accounts for the hierarchical structure of the data, where women (Level 1) were nested within communities or clusters (Level 2). This approach allowed for the estimation of both fixed effects (individual-level and community-level predictors) and random effects (unobserved heterogeneity across communities). Intra-class correlation coefficients (ICCs) were calculated to quantify the proportion of the total variance attributable to differences between communities. The concentration Index (CI) and Concentration curve (CC) were also calculated to measure the socio-economic inequality of exclusive use of hygienic methods among reproductive-age women.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDifferentials in use of various types of menstrual products\u003c/h2\u003e \u003cp\u003eThe distribution of various menstrual hygiene products according to age is represented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of seven methods have been reported to protect from bloodstains during menstruation. Disposable menstrual pads (59.8%) and cloth (47.6%) were the most commonly used across all age groups. However, a very small percentage of women used tampons and menstrual cups. Age-wise results show that over 75 percent of young women (15\u0026ndash;24) used a disposable sanitary pad. About 59 percent of women in the older age group (35 years and above) use cloth to prevent menstruation. It is very surprising to report that still more than 10 percent of older age women (35 years and above) either used underwear to prevent bloodstains during menstruation or did not use anything.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifferentials in the use of various types of menstrual products among reproductive-age women, Nepal 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of menstruation products\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAll women (Total)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 years and above\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReusable Sanitary Pads \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisposable Sanitary Pads \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e41.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCloth \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e58.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTampons \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMenstrual Cup \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToilet Paper/Cotton Wool \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderwear Only \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNothing \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote\u003c/b\u003e: Total percentage exceeds 100 due to multiple responses. \u003cb\u003eA\u003c/b\u003e: Hygienic product, \u003cb\u003eB\u003c/b\u003e: Unhygienic product\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSocio-demographic and economic characteristics of the study participants\u003c/h3\u003e\n\u003cp\u003eWe evaluated the socio-demographic and economic characteristics of Nepalese women aged (15\u0026ndash;49) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Out of 13,065 reproductive-age women in Nepal, more than one-third (37.2%) were in the young (15\u0026ndash;24 years) age group. The mean age of the women was 33.33 years, ranging from 15 to 49 years. Most women (65.5%) had their menarche between 13 and 15 years of age. About one-fourth of women were never married, while nearly one-third (33.4%) had less than 5 years of schooling. A majority of women (70%) were living in households that had improved sanitation facilities. In terms of restrictions on activities during the menstrual period, more than 50 percent of women reported facing restrictions on at least 1\u0026ndash;2 activities during menstruation. More than half of women (52.1%) had exposure to mass media at least once a week, and 61.5% had personal smartphones. Only 16.5% of women were in white-collar jobs, while 27.9% of the women currently did not work. The majority of respondents (68.8%) lived in urban areas of the country. However, only 5.1% of the women lived in the mountain region, and more than 50% lived in the Terai region. At the community level, education (60.6%) and wealth are high (62.3%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWeighted percentage distribution of reproductive-age women by background characteristics in Nepal, 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBackground Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (13,065)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividual-level variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of the women (in years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.33 (7.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at menarche (in years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8,556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not remember\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of schooling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRich\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of home\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNatal home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRestrictions on activities during menstrual period\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo restriction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,960\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHouseholds using improved sanitation facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8,735\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEcological region\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMountain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerai\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProvince\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKoshi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMadhesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBagmati\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGandaki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLumbini\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKarnali\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSudurpashchim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8,985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation of the woman\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite collar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlue collar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOwns a smartphone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8,033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExposure to mass media (Newspaper/Radio/Television)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,652\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than once a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt least once a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity-level variables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity wealth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8,137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity exposure to media\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNote\u003c/b\u003e: N\u0026thinsp;=\u0026thinsp;sample size\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eExclusive use of hygienic methods by provinces of Nepal\u003c/h3\u003e\n\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the distribution of women using the hygiene method for menstrual blood collection. Overall, 47.6% of women used hygienic methods. Exclusive use of hygienic methods varied across provinces of Nepal. Only 35.8% of women living in Karnali province exclusively used hygienic methods, while 59% of women residing in Bagmati and Gandaki provinces used hygienic methods only.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDifferentials in exclusive use of hygienic methods among reproductive-age women\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the proportion of reproductive-age women using only hygienic methods based on background characteristics in Nepal. The exclusive use of hygienic methods was two times higher among young women (aged 15\u0026ndash;24) (62.3%) than older women (35 years and above) (31.0%). Similarly, it was higher among women who had menarche before 13 years of age. It was also found that never-married women used more hygienic methods (71%) than ever-married women (40.1%). Moreover, the exclusive use of hygienic methods was three times higher among women with 10 years and above schooling (68.3%) than women with less than 5 years of education (23.8%). Women from affluent households had a higher proportion of exclusively used hygienic methods (65.3%) than women from poor families (29.8%). About one-third (32.4%) of women who faced multiple restrictions (more than five activities) on their daily activities during menstruation had a lower percentage of using hygienic methods. It was also found that women from rural areas (38.8%) used less hygienic methods than women from urban areas (51.5%).\u003c/p\u003e \u003cp\u003eSimilarly, the use of hygienic methods was lower among women residing in mountain regions (33.7%) compared to women living in hill (51.4%) or terai regions (46.0%), respectively. The exclusive use of hygienic methods was significantly higher among women who are currently not working (60.7%) and women working in white-collar jobs (70.5%) than women working in blue-collar jobs (34.1%). Women with exposure to mass media at least once a week exclusively used more hygienic methods (54%) than those without exposure to media (36.6%). In addition, women who owned smartphones had higher exclusively used hygienic methods (57.6%) than women who did not (31.6%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExclusive use of hygienic methods during menstruation among reproductive-age women by selected Background characteristics, Nepal 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBackground characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusively use hygienic methods\u003c/p\u003e \u003cp\u003e(% weighted)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividual-level variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of the women (in years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at menarche (in years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not remember\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of schooling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRich\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of home\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNatal home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRestrictions on activities during menstrual period\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo restriction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHouseholds using improved sanitation facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEcological region\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMountain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerai\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProvince\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKoshi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMadhesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBagmati\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGandaki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLumbini\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKarnali\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSudurpashchim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation of the woman\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite collar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlue collar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOwns a smartphone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExposure to any mass media (Newspaper/Radio/TV)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than once a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt least once a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity-level variables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity wealth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity exposure to media\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eVariance estimates across communities and intra-class correlation coefficients (ICCs)\u003c/h2\u003e \u003cp\u003eA model applied without covariates (called the null model) on the exclusive use of hygienic methods among reproductive-age women (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) showed significant variation in the exclusive use of hygienic methods communities. Based on intra-class correlation coefficient (ICC) values, 16.6% of the total variance in using hygienic methods was attributable to differences across communities. After including individual variables (Model 1) in the null model, the ICC values decreased to 9.2% (community level).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariance estimates across communities and intra-class correlation coefficients (ICCs) for the multilevel models for exclusive use of hygienic methods among reproductive-age women\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCommunity (PSU)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariance (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICC (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNull model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.653 (0.548, 0.777)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.6 (14.3, 19.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjusted model (Model 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.335 (0.269, 0.418)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.2 (7.6, 11.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eResults of the multilevel logistic regression model\u003c/h2\u003e \u003cp\u003eThe determinants of the exclusive use of hygienic methods were examined using a multilevel logistic regression model. Results of the multilevel model show that young women aged 15\u0026ndash;24 years (AOR\u0026thinsp;=\u0026thinsp;2.51, CI: 2.18\u0026ndash;2.89) were 2.5 times and women aged 25\u0026ndash;34 (AOR\u0026thinsp;=\u0026thinsp;1.69, CI: 1.50\u0026ndash;1.90) were 1.69 times more likely to exclusively use hygienic methods than women aged 35 years and higher. The odds of exclusive use of hygienic methods in women were 44% higher among never-married women (AOR\u0026thinsp;=\u0026thinsp;1.44, CI: 1.21\u0026ndash;1.72) than their married counterparts. Women with 10 years and above of schooling (AOR\u0026thinsp;=\u0026thinsp;1.98, CI: 1.73\u0026ndash;2.27) were 98%, and women with 5\u0026ndash;9 years of schooling (AOR\u0026thinsp;=\u0026thinsp;1.80, CI: 1.60\u0026ndash;2.02) were 80% more likely to use hygienic methods than women with less than 5 years of schooling. The odds of exclusive use of hygienic methods were 2.16 times higher among women in rich households (AOR\u0026thinsp;=\u0026thinsp;2.16, CI: 1.87\u0026ndash;2.49).\u003c/p\u003e \u003cp\u003eRestrictions on women during their menstruation period were negatively associated with the use of hygienic methods. Women with no restrictions (AOR\u0026thinsp;=\u0026thinsp;1.42, CI: 1.18\u0026ndash;1.71) were 42% more likely to use hygienic methods than women with five or more restrictions on activities, respectively. The odds of exclusive use of hygienic methods varied significantly by the occupational status of the woman. Regarding women working in blue-collar jobs, exclusive hygienic methods were used twice among women in white-collar jobs (AOR\u0026thinsp;=\u0026thinsp;2.14, CI: 1.87\u0026ndash;2.45). The chances of exclusive use of hygienic methods were 41% higher among women who owned a smartphone than those who did not (AOR\u0026thinsp;=\u0026thinsp;1.41, CI: 1.28\u0026ndash;1.56). In addition, women exposed to mass media at least once a week were 36% more likely to use hygienic methods than women without exposure to mass media (AOR\u0026thinsp;=\u0026thinsp;1.36, CI: 1.20\u0026ndash;1.54). At the community level, higher community wealth was positively associated with the exclusive use of hygienic methods during menstruation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultilevel logistic regression analysis assessing the effect of background characteristics on the exclusive use of hygienic methods among reproductive age women in Nepal, 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBackground Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdjusted odds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eLower Upper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividual-level variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of the women (in years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at menarche (in years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of schooling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e05-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRich\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of home\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNatal home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRestrictions on activities during menstrual period\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo restriction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHouseholds using improved sanitation facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEcological region\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMountain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerai\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation of the woman\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite collar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlue collar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOwns a smartphone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExposure to mass media\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Newspaper/Radio/Television)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than once a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt least once a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity-level variables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity wealth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity exposure to media\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the concentration curve for the exclusive use of hygienic methods among reproductive-age women in Nepal. The concentration curve (CC) lies below the line of equality; it implies that the exclusive use of hygienic methods among women is concentrated among the rich. Moreover, if CC were formed above the line of equality, the inequality would concentrate on the poor and vice-versa. Additionally, the more areas between the line of equality and the curve, the higher the inequality. Nepal had an inequality of 0.21, which describes that exclusive use of hygienic methods was concentrated among rich women. Among the geographical regions of Nepal, the highest inequality was witnessed in Madhesh province (0.25), followed by Bagmati province (0.22). The lowest inequality was observed in Sudurpashchim province (0.08), followed by Karnali province (0.11). In all the provinces of Nepal, the exclusive use of hygienic methods is concentrated among rich women only.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the restrictions faced by women during their menstruation period in Nepal by province for each activity. In Nepal, about 65% of women were not allowed to enter the temple or to get involved in religious activities, and one-third of women were also not allowed to touch or cook food during menstruation. In addition, 14.3% of women were restricted even from fetching water to plants.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study aimed to evaluate the factors influencing exclusive use of hygienic methods during menstruation among reproductive-age women in Nepal. Using nationally representative recent data from Nepal, this study is one of the first studies to highlight various socio-demographic predictors of exclusive use of hygienic methods during the menstruation period in Nepal. Our study shows that only 48% of reproductive-age women exclusively used the hygienic method during menstruation. However, 39% of women reported that they are still using unhygienic menstrual absorbents such as old clothes, rags, or other unclean menstruation absorbents. The exclusive use of hygienic methods was seen to be higher than the studies conducted in Pakistan (25%) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], Ethiopia (46.4%) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and sub-Saharan Africa (45%) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Contrary to the findings of this study, a higher prevalence (50\u0026ndash;70%) of using hygienic method was obtained in a similar study conducted in India [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The possible explanation for discrepancies is mainly due to socioeconomic and cultural differences between countries that directly affect menstrual hygiene practices. Furthermore, it can be due to the difference in implementing programs and schemes at school and community level on menstruation hygiene management.\u003c/p\u003e \u003cp\u003eThe present study identified several important individual, household, and community-level factors significantly associated with hygienic menstrual practices. The analysis also indicated a significant difference in the use of exclusive menstrual hygiene practices across Nepal's provinces and ecological levels. In this study, multivariable analysis showed that young women (15\u0026ndash;24 years of age) with higher years of schooling, never-married women, women who belonged to the richest wealth quintiles, no restrictions on activities during the menstrual period, owned smartphone, exposed to mass media at least once a week, worked into a white-collar job, and higher community wealth were significantly higher usage of menstrual hygiene product than their counterpart.\u003c/p\u003e \u003cp\u003eThe odds of exclusive use of hygienic methods decreased with the increase in age of women. We found that exclusive use of hygienic methods was significantly higher among younger women (15\u0026ndash;24) than their older counterparts (aged 35 and above). This finding corroborates a previous study in Nepal that analyzed adolescent girl practicing more hygienic methods (67%) during the mensuration period than their counterpart [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This finding also aligns with the study from India and Bangladesh [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This result implies that younger women are more aware and serious regarding the importance of hygienic methods during menstruation. In recent years, the Nepalese government and other non-governmental organizations (NGOs), specifically UNICEF, have promoted the WASH for Schools (WinS) program and provided menstrual management facilities in schools to encourage hygienic and safe menstruation habits among adolescent girls. As a result, it has positively impacted knowledge and practices of hygiene menstruation among young women [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This study also highlighted that the exclusive use of hygienic methods was more prevalent among never-married women than married women. Similar results were reported from another study conducted in India that found exclusive hygienic methods were relatively higher among unmarried women (71.0%) than married women [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A possible explanation for these similarities may be that most of the unmarried women enrolled in school or colleges have more opportunities to obtain relevant information about menstrual hygiene and safe hygiene practicing during menstruation than those who are married and have less exposure to getting information.\u003c/p\u003e \u003cp\u003eThe present study also demonstrated that increased educational years was significantly associated with a decrease in poor menstrual hygiene practices. We found that women who had ten years and above educational levels had more chances of using an appropriate menstrual practice than women with less than \u0026lt;\u0026thinsp;5 years of schooling. This finding is in line with previous studies conducted in Nepal and other countries [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These studies consistently show that women with a higher level of education understand the benefits of using hygienic methods and are more aware of the risks associated with unhygienic menstruation practices. The exclusive use of hygienic menstrual practices is also significantly associated with the household's wealth status. Previous studies have documented that the prevalence of exclusive hygienic method is relatively low among women belonging to poor families [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Our results confirm the same and indicate that women who belonged to affluent families used twice the exclusive use of hygienic methods as poor women. The results from the concentration curve also demonstrated that the exclusive use of hygiene methods among women is concentrated in women from higher economic backgrounds. This is probably because women from lower income households are unable to seek higher education and are not able to afford sanitary products, which results in poor menstrual practices [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Another important finding of this study is that women who faced any menstrual restrictions, such as not allowed to enter the temple or get involved in religious activities, or women were also not allowed to touch or cook in the kitchen, are more likely to practice unhygienic menstruation methods than those who did not face any menstrual restriction. It is also reflected in our results that 85% of Nepalese women experience some sort of menstrual restriction. This result is consistent with a study in Nepal, which mentioned that due to social and individual restrictions against women when menstruating there are significant changes have been observed in menstrual practices [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Our findings highlighted deeply rooted menstruation-related socio-cultural and religious restrictions that continue to affect menstrual hygiene practices among Nepalese women. Unfortunately, these restrictions are still widespread and often overlooked by the society [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Regarding the province-based distribution of exclusive use of menstrual hygiene practices, we found geographical heterogeneity across Nepal, with Madhesh province and Bagmati province having the highest inequality of 0.25 and 0.22 during the study period. Alternatively, two northern provinces, Karnali and Sudurpashchim, showed comparatively good menstruation practices.\u003c/p\u003e \u003cp\u003eAnother significant finding of this study was the positive role of women\u0026rsquo;s exposure to mass media on menstrual hygiene practices. The finding of this study revealed that exposure to mass media at least once a week is significantly associated with exclusive use of hygienic methods. The finding was congruent with a study conducted on school adolescents in Nepal reported that 70% of the girls received information on menstruation from the local radio station [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Many previous studies suggest that exposure to diverse mass media can play a prominent role in disseminating information, including menstruation and menstrual hygiene-related topics [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Our study also found that the ownership of smartphones was significantly associated with higher use of hygienic methods during menstruation. This finding is consistent with earlier studies conducted in India and Bangladesh [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The finding indicates that access to mobile phones is important in addressing awareness among women on menstruation practices as mobile phones provide easy access to information. Also, information on menstruation through various media and digital awareness among women reduces societal stigma on menstruation and promotes the safe and hygienic menstruation practice [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStrength and Limitations\u003c/h2\u003e \u003cp\u003eThe present study exhibits several notable strengths. This is the first study on this topic at the national level that assesses the exclusive use of mensuration hygienic methods among Nepalese women. Moreover, the data quality and large sample size ensure the generalization of the findings. Secondly, the study identified potential determinants that are significantly associated with hygienic menstruation practices. The study's outcome will be important information for Nepal government and public health practitioners to design a programmatic set of actions to address the menstruation problems in the country. Moreover, this study provides further direction for future research to explore and enable appropriate solutions to hygiene menstrual practices. Nevertheless, our study has some limitations. The study's cross-sectional nature makes it difficult to build causal relationships between the outcome and exposure variables. The reliance on self-reported nature of the data can be subject to recall bias and social desirability bias. Also, due to the unavailability of data, we were unable to investigate the association between knowledge and awareness of women on mensuration hygiene practices.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe study shows that less than half of the women are using hygienic menstrual practices. The findings suggest the need for multidimensional interventions and educational programs targeting socio-economically vulnerable women to address unhygienic menstrual practices. More research is needed to determine the effect of social norms, stigma, and restrictions on menstruation hygiene practices. Also, a special focus on providing poor households and communities with subsidized or free menstrual hygiene products can reduce the disparities. Engagement of digital media in advocating for menstruation management can help raise awareness throughout society. There is a need for a strategic approach to combating the myths and social taboos associated with menstruation to improve the practices of exclusive use of hygienic menstruation. Also, there is a need to educate adult women on biological facts and good hygienic practices, as they can impose cultural taboos and restrictions on the next generation. Findings recommend multidimensional interventions and educational programs needed for socioeconomically vulnerable women to address unhygienic menstrual practices.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is based on secondary data which is available in public domain. Therefore, ethical approval is not required for conducting this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests in this section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll author has made substantial contributions to the conception and design of the work. P.K. analysis the data, P.K and N.H. interpretation of data, P.K and N.H. prepared tables 1-5, N.H and R.R. prepared figures 1-3, R.R. wrote the first draft of the main manuscript. PK and RR reviewed and finalized the manuscript for publication\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank Raghu Varma, an independent researcher from Lucknow, India, for his invaluable assistance in English editing this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO/UNICEF. Guidance on Menstrual Health and Hygiene. 2019 [Internet]. Available from: https://www.unicef.org/media/91341/file/UNICEF-Guidance-menstrual-health-hygiene-2019.pdf\u003c/li\u003e\n\u003cli\u003eMukherjee A, Lama M, Khakurel U, Jha AN, Ajose F, Acharya S, et al. Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey. Reprod Health. 2020 Dec;17(1):81. \u003c/li\u003e\n\u003cli\u003eBhusal CK. Practice of Menstrual Hygiene and Associated Factors among Adolescent School Girls in Dang District, Nepal. Adv Prev Med. 2020 Jul 24; 2020:1\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eSharma A, McCall-Hosenfeld JS, Cuffee Y. Systematic review of menstrual health and hygiene in Nepal employing a social ecological model. Reprod Health. 2022 Dec;19(1):154. \u003c/li\u003e\n\u003cli\u003eWorld Bank Group. Menstrual Health and Hygiene. 2022. Available at: https://www.worldbank.org/en/topic/water/brief/menstrual-health-and-hygiene#:~:text=Menstrual%20Health%20and%20Hygiene%20(MHH,menstrual%20hygiene%20management%20(MHM). Accessed on June 23, 2024.\u003c/li\u003e\n\u003cli\u003eKhanal G, Shrestha N, Adhikari K, Ghimire U. Menstruation hygiene management among secondary school students of Chitwan, Nepal: a cross-sectional study. BMC Womens Health. 2023 Jul 26;23(1):395. \u003c/li\u003e\n\u003cli\u003eMinistry of Health and Population [Nepal], New ERA, and ICF. Kathmandu, Nepal: Ministry of Health and Population [Nepal]. Nepal Demographic and Health Survey 2022. Available at: https://dhsprogram.com/pubs/pdf/FR379/FR379.pdf Accessed on June 6, 2024.\u003c/li\u003e\n\u003cli\u003eUNICEF and WaterAid South Asia Regional Team. Menstrual Hygiene in Schools in South Asia: Synthesis Report. 2021. Available at: https://washmatters.wateraid.org/sites/g/files/jkxoof256/files/menstrual-hygiene-management-in-schools-in-south-asia---synthesis-report.pdf Accessed on June 7, 2024.\u003c/li\u003e\n\u003cli\u003eBasyal S. How Menstruation is shaping Girls\u0026rsquo; Education in Rural Nepal. 2016. e Journal of Education Policy. Available at: https://files.eric.ed.gov/fulltext/EJ1158204.pdf Accessed on July 1, 2024.\u003c/li\u003e\n\u003cli\u003eSapkota A, Karn VL, Chand S, Shastry CS, Pant BD. Knowledge and Practice of Menstrual Hygiene among Adolescent Girls inPanauti Municipality, Kavrepalanchowk, Nepal: A Study from Low Middle-income Country. Curr Women Health Rev. 2022 May;18(2): e041021192819. \u003c/li\u003e\n\u003cli\u003eSingh A, Chakrabarty M, Singh S, Chandra R, Chowdhury S, Singh A. Menstrual hygiene practices among adolescent women in rural India: a cross-sectional study. BMC Public Health. 2022 Nov 19;22(1):2126. \u003c/li\u003e\n\u003cli\u003eShanta Upadhya \u0026amp; Anup Adhikari. Menstruation Hygiene Practices Among Girl Students in Kathmandu Valley. 89 Pragyaratna, Vol: 5, Issue: 1, 2023. ISSN: 977-2565-5000-04\u003c/li\u003e\n\u003cli\u003eYadav, Joshi. Knowledge, Attitude, and Practice on Menstrual Hygiene Management among School Adolescents. JNHRC Vol. 15 No. 3 Issue 37, 212-216\u003c/li\u003e\n\u003cli\u003eYUWA. Menstrual Hygiene Management in Nepal. 2018 [Internet]. Available from: https://www.asiapacificalliance.org/application/files/7415/5963/8758/YUWA_Menstrual_Hygiene_Management_in_Nepal__2018.pdf Accessed on June 4, 2024.\u003c/li\u003e\n\u003cli\u003eUNICEF. Menstrual health and hygiene management still out of reach for many. 2022 [Internet]. Available from: https://www.unicef.org/press-releases/fact-sheet-menstrual-health-and-hygiene-management-still-out-reach-many Accessed on June 13, 2024.\u003c/li\u003e\n\u003cli\u003eCardoso LF, Clark CJ, Rivers K, Ferguson G, Shrestha B, Gupta J. Menstrual restriction prevalence and association with intimate partner violence among Nepali women. BMJ Sex Reprod Health. 2019 Jan;45(1):38\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eKumar R, Maity B. Cultural norms and women\u0026rsquo;s health: Implications of the practice of menstrual restrictions in Nepal. World Dev Perspect. 2022 Sep; 27:100450. \u003c/li\u003e\n\u003cli\u003eThakuri DS, Thapa RK, Singh S, Khanal GN, Khatri RB. A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication. Federici S, editor. PLOS ONE. 2021 Sep 1;16(9): e0256968. \u003c/li\u003e\n\u003cli\u003eThapa S, Aro AR. \u0026lsquo;Menstruation means impurity\u0026rsquo;: multilevel interventions are needed to break the menstrual taboo in Nepal. BMC Womens Health. 2021 Dec;21(1):84. \u003c/li\u003e\n\u003cli\u003eWasan Y, Baxter JAB, Rizvi A, Shaheen F, Junejo Q, Abro MA, et al. Practices and predictors of menstrual hygiene management material use among adolescent and young women in rural Pakistan: A cross-sectional assessment. J Glob Health. 2022 Aug 10; 12:04059. \u003c/li\u003e\n\u003cli\u003eAhmed Shallo S, Willi W, Abubeker A. Factors Affecting Menstrual Hygiene Management Practice Among School Adolescents in Ambo, Western Ethiopia, 2018: A Cross-Sectional Mixed-Method Study. Risk Manag Healthc Policy. 2020 Sep; Volume 13:1579\u0026ndash;87. \u003c/li\u003e\n\u003cli\u003eAnbesu EW, Asgedom DK. Menstrual hygiene practice and associated factors among adolescent girls in sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health. 2023 Jan 6;23(1):33. \u003c/li\u003e\n\u003cli\u003eMeher T, Sahoo H. Dynamics of usage of menstrual hygiene and unhygienic methods among young women in India: a spatial analysis. BMC Womens Health. 2023 Nov 6;23(1):573. \u003c/li\u003e\n\u003cli\u003eRoy A, Paul P, Saha J, Barman B, Kapasia N, Chouhan P. Prevalence and correlates of menstrual hygiene practices among young currently married women aged 15\u0026ndash;24 years: an analysis from a nationally representative survey of India. Eur J Contracept Reprod Health Care. 2021 Jan 2;26(1):1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eAfiaz A, Biswas RK. Awareness on menstrual hygiene management in Bangladesh and the possibilities of media interventions: using a nationwide cross-sectional survey. BMJ Open. 2021 Apr;11(4): e042134. \u003c/li\u003e\n\u003cli\u003eShrestha S, Shrestha S, Ito Y, Kobayashi Y, Nishida K, Futaba K, et al. Situation of menstrual management facilities in schools of peri-urban areas of Nepal: WASH, privacy, and healthcare. J Water Sanit Hyg Dev. 2022 Jan 1;12(1):41\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eDhakal. Analysis of menstrual hygiene practices in Nepal: the role of WASH in Schools programme for girls\u0026rsquo; education. 2018. 41st WEDC International Conference, Egerton University, Nakuru, Kenya, 2018. Paper 2870 Available at: https://wedc-knowledge.lboro.ac.uk/resources/conference/41/Dhakal-2870.pdf Accessed on July 2, 2024.\u003c/li\u003e\n\u003cli\u003eMadhusudan Subedi, Sara Parker. Menstrual Exclusions in Nepal: Some Evidence of Transition. Dhaulagiri Journal of Sociology and Anthropology Vol. 15, 2021, pp. 1-9. Available at: https://www.nepjol.info/index.php/DSAJ/article/view/41921 Accessed on July 6, 2024.\u003c/li\u003e\n\u003cli\u003eUpashe SP, Tekelab T, Mekonnen J. Assessment of knowledge and practice of menstrual hygiene among high school girls in Western Ethiopia. BMC Womens Health. 2015 Dec;15(1):84. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Menstrual hygiene, Reproductive age women, Inequality, Nepal","lastPublishedDoi":"10.21203/rs.3.rs-5286445/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5286445/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eExclusive use of hygienic methods during menstruation has not received adequate attention in Nepal, with limited research utilizing nationally representative data. Therefore, this study explored the prevalence and factors influencing exclusive hygienic menstrual practices among women of reproductive age in Nepal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study included 13,066 reproductive-age women from the Nepal Demographic and Health Survey (NDHS-2022). A binary logistic regression model was applied to identify significant factors of exclusive use of hygienic methods among women in Nepal. To quantify the proportion of the total variance attributable to differences between communities. The concentration Index (CI) and Concentration curve (CC) were also calculated to measure the socio-economic inequality of exclusive use of hygienic methods among reproductive agewomen.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Only 48% of Nepalese women aged 15- 49 years used exclusively hygienic methods to prevent bloodstains during menstruation. The results of the multivariate model revealed that young women aged 15-24 (AOR=2.51, p\u0026lt;0.001), women with 10 years and above education (AOR=1.98, p\u0026lt;0.001) from the richest wealth quintile (AOR=2.16, p\u0026lt;0.001), never married women (AOR=1.44, p\u0026lt;0.001), owned a smartphone (AOR=1.41, p\u0026lt;0.001) and women with exposure to mass media at least once a week (AOR=1.36, p\u0026lt;0.001) are more likely to use hygienic methods as compared with their counterparts. The results from the concentration curve also demonstrated that exclusive use of hygiene methods among women is concentrated in women from higher economic backgrounds (CI: 0.21). Among the geographical regions of Nepal, the highest inequality was witnessed in Madhesh province (CI: 0.25), followed by Bagmati province (CI: 0.22).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The findings suggest the need for multidimensional interventions and educational programs targeting socioeconomically vulnerable women to address unhygienic menstrual practices. Also, there is a need to educate adult women on biological facts and good hygienic practices, as they can impose cultural taboos and restrictions on the next generation.\u003c/p\u003e","manuscriptTitle":"Drivers of Hygienic Menstrual Practices among Reproductive-Age Women: Evidence from Nepal Demographic Health Survey-2022","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-21 05:40:41","doi":"10.21203/rs.3.rs-5286445/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-08T07:44:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-08T06:27:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-03T21:14:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213234498407001628753675313830382477527","date":"2024-11-26T00:20:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3243395661578308785231268351950223873","date":"2024-11-23T21:48:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-23T14:58:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277889362501303046595099621999342674857","date":"2024-11-09T08:53:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-01T19:18:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-18T11:45:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-18T11:44:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"Reproductive Health","date":"2024-10-18T04:46:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03091c89-0a66-4a97-b080-ce3da4c528f5","owner":[],"postedDate":"October 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-17T16:05:00+00:00","versionOfRecord":{"articleIdentity":"rs-5286445","link":"https://doi.org/10.1186/s12978-025-01976-5","journal":{"identity":"reproductive-health","isVorOnly":false,"title":"Reproductive Health"},"publishedOn":"2025-03-12 15:58:34","publishedOnDateReadable":"March 12th, 2025"},"versionCreatedAt":"2024-10-21 05:40:41","video":"","vorDoi":"10.1186/s12978-025-01976-5","vorDoiUrl":"https://doi.org/10.1186/s12978-025-01976-5","workflowStages":[]},"version":"v1","identity":"rs-5286445","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5286445","identity":"rs-5286445","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}