Menstrual material deprivation and participation constraints among women: a study of Assam

Menstrual material deprivation, also known as period poverty, is a complex public health issue that includes poor sanitation, restricted access to menstrual goods, and a lack of awareness regarding safe menstruation management. Women from lower socio-economic background are disproportionately affected which is associated with reduced participation in social life, employment, and education. Assam, a predominantly rural state in Northeast India marked by socio-economic inequality and uneven access to sanitation and health infrastructure, provides an important context for examining menstrual material deprivation and its implications for women's participation. Evidence from India indicates substantial regional variation in menstrual material use, with northeastern states, including Assam, showing higher reliance on reusable materials compared to southern states.

This study adopts a cross-sectional secondary analysis of National Family Health Survey (NFHS-5, 2019-2021) data for women aged 15-24 years in Assam. The analytic sample included women aged 15-24 years in Assam with complete information on menstrual material use and participation-related variables. Menstrual material deprivation was approximated using type of menstrual absorbent (cloth/other vs. disposable pads), while socio-economic characteristics such as wealth, education, residence, and sanitation access were analysed as structural determinants. Women's well-being was examined through behavioural and participation outcomes, specifically restricted mobility and absenteeism from school or work. Descriptive statistics were used to estimate the prevalence of menstrual material use across socio-economic groups. Survey-adjusted Rao-Scott chi-square tests were conducted to examine associations between menstrual material type and socio-economic characteristics. Survey-weighted multivariable logistic regression models were used to estimate adjusted associations between menstrual material use, sanitation access, and participation constraints. Participation restriction was coded "1" if respondents reported either restricted mobility during menstruation or absenteeism from school/work, and "0" otherwise.

Overall, 48% of women reported using cloth or other reusable materials, while 52% used disposable sanitary pads. Cloth use was highest among women in the lowest wealth quintile (70%), those with no schooling (58%), and rural residents (53%) (p < 0.001). Participation restrictions were significantly higher among cloth users (42%) compared to pad users (15%) (p < 0.001), and among women without improved sanitation (45% vs. 20%, p < 0.001). In multivariable analysis, cloth users were nearly four times more likely to experience participation restrictions (AOR = 3.85; 95% CI: 3.45-4.30), as did women lacking improved sanitation (AOR = 2.64; 95% CI: 2.31-3.02).

Menstrual material deprivation in Assam reflects broader socio-economic and infrastructural inequalities rather than individual preference. Integrated interventions addressing menstrual product access, sanitation, education, and social norms are essential to enhance women's well-being and enable them to fully participate in daily life.