Religious Affiliation and Reported Dual Menstrual Material Use Among Young Women in India

Background: Dual-method menstrual hygiene use, defined as the use of both modern menstrual hygiene products (e.g., sanitary pads) and traditional materials (e.g., cloth), remains under-researched among young women in India. While socioeconomic factors are associated with menstrual practices, religious affiliation may also be associated with differences in reported material use. This study examined the association between religious affiliation and dual-method use among women aged 15-24 years using nationally representative survey data supplemented by contextual evidence from the qualitative and contextual literature. Methods: Quantitative analysis used nationally representative National Family Health Survey-V (NFHS-V, 2019-21) data for 240,230 women aged 15-24 years. Survey-weighted bivariate and multivariable logistic regression analyses estimated the prevalence and adjusted odds of reported dual-method use across sociodemographic and religious groups. Seven purposively selected qualitative and contextual sources were used to provide contextual insights into the quantitative findings. Results: Muslim women had the highest prevalence of reported dual-method use (31.7%), compared with 27.5% among Hindu women and 21.6% among other religious groups. The association between religious affiliation and dual-method use was also observed across several demographic subgroups. Among women with improved toilet facilities, dual-method use was higher among Muslim women than Hindu women (32.3% vs. 27.0%). Similarly, among women with higher education, prevalence was 30.1% among Muslim women compared with 23.3% among Hindu women. After adjustment for measured sociodemographic, socioeconomic, structural, and regional characteristics, Muslim women had 36% higher odds of reported dual-method use than Hindu women (AOR 1.36, 95% CI: 1.29-1.43; p < 0.001). The qualitative and contextual literature provided contextual insights into the potential roles of privacy, household expectations, and disposal concerns in menstrual material use. However, NFHS-V cannot establish whether materials were used concurrently or sequentially or identify the specific contexts of use. Conclusions: Religious affiliation was associated with dual-method menstrual hygiene use after adjustment for socioeconomic and demographic characteristics. The findings indicate that menstrual health interventions should address socioeconomic barriers alongside the social and cultural contexts in which menstrual practices occur. Community-informed approaches incorporating privacy, disposal, household norms, and infrastructure may complement product provision and contribute to more equitable menstrual health outcomes.