Linkages of drought and menstrual hygiene practices of adolescent girls and young women: an assessment of 707 districts in India.

Abstract

Background: Drought causes severe water scarcity, which might impede sanitation and hygiene practices. India is a drought-prone country and it is also striving to attain better sanitation and hygiene practices. This study explores drought conditions in India and its link with the menstrual hygiene practices of adolescent girls and young women.

Methods: The drought conditions were explored by computing a Satellite-Based Aridity Index (SbAI) using data from the Moderate Resolution Imaging Spectroradiometer (MODIS), whereas, the menstrual hygiene practices (absorbent use) were analyzed using the National Family Health Survey (NFHS-5) 2019-21, comprising responses collected from adolescent girls aged 15 to 19 years (N = 1,22,480), and young women of 20 to 24 years (N = 1,18,700), across the districts of India (N = 707). For assessing the linkages between drought and menstrual hygiene, the study applied spatial autocorrelation, logistic regression, Ordinary Least Squares (OLS) regression, and Spatial Lag Model (SLM). Path analysis was performed to examine the direct and indirect effects of drought on menstrual hygiene practices through water availability and sanitation.

Results: Approximately 45% of the sampled population was exposed to drought condition. Around 30% lacked access to water on their household premises, and 18% did not have toilet facilities. The western part of India was the most drought-affected area during this period. The study found a strong association between unhygienic menstrual absorbent use and exposure to drought in India (OR = 1.29, CI: 1.27, 1.32). Drought and unhygienic menstrual absorbent use were prevalent in 65 districts, primarily in western and central India. In certain districts of Uttar Pradesh, Bihar, and Assam, despite less drought condition, a large proportion of women were using unhygienic menstrual practices. The study also revealed that drought worsened menstrual hygiene absorbent usage directly and indirectly through lack of water availability and toilet facilities.

Conclusion: The study emphasizes the need for district-specific policy interventions with distinct takes on districts with high drought and high prevalence of unhygienic menstrual practices, as well as for districts with low drought yet a high prevalence of unhygienic menstrual practices.