Menstrual hygiene management and fertility in Togo: Exploring the causal pathways

BackgroundMenstrual hygiene management (MHM) remains a neglected concern in Togo, despite its critical importance for the education, health, and dignity of girls and women. Neglecting MHM directly impacts women's reproductive morbidities that may adversely affect fertility outcomes. However, there is limited literature on MHM practices in Togo and their impact on individual fertility.ObjectivesThe study aims to examine the (1) effects of structural determinants-namely WASH infrastructure, socio-economic disparities, and social norms on menstrual hygiene practices, and (2) causal effect of MHM on reproductive health outcome, measured in terms of fertility of Togolese women. Considering the endogeneity of MHM, we aim to provide evidence that the roles of WASH facilities, social norms, and socio-economic factors influence MHM and thereby linking it directly to fertility of women.DesignThe study uses secondary data from a cross sectional survey of nationally representative Multiple Indicator Cluster Survey (MICS6, 2017) for Togo.MethodsWe have used control function (CF) approach to address the endogeneity of MHM to estimate the causal inference of MHM on the fertility of ever-married women aged between 15-49 years in Togo. The source of endogeneity of MHM is explained through the channels of social exclusion-related unobservable, and availability of WASH facilities.ResultsThe access to WASH facilities improve the probability of MHM by 31-53 percentage points. Our study establishes the existence of a strong causal relationship between MHM and fertility rate, establishing the endogeneity of MHM. The fertility increases (4-5%) significantly for women who manage their menstrual hygiene.ConclusionEffective MHM is crucial for individual dignity, health, and well-being. Our study indicates that proper menstrual hygeine management has significantly affect the reproductive health of women measured in terms of fertility. To foster an enabling environment of MHM concerned, the study recommended a few public policy interventions.