Spatial heterogeneity of menstrual discriminatory practices against Nepalese women: a population-based study using the 2022 Demographic and Health Survey

AbstractBackgroundMenstrual discrimination hinders progress toward Sustainable Development Goals including gender equality, health, education, and sanitation. Examining spatial heterogeneity of menstrual discriminatory practices presents an opportunity for targeted interventions. Our goal was to evaluate geographical disparities in menstrual restrictions among Nepalese women and assess their association with socio-economic and demographic factors.MethodologyWe utilized data from the 2022 Nepal Demographic and Health Survey, focusing on women aged 15 to 49 who had experienced a menstrual period in the last year. Our analysis explored the spatial patterns of menstrual restriction outcomes related to engagement in religious activities, household level restrictions, and the severe form of menstrual restrictions referred toChhaupadi. The standard Gaussian kernel density estimation was used to create continuous prevalence maps and the spatial scan statistic was used to detect local clusters. The association between the different forms of menstrual restriction and the socio-economic, and demographic factors were examined using the Poisson regression model with robust standard errors.FindingsOverall, the prevalence of women who reported any form of menstrual restriction was 84.8% and was subject to geographical variations ranging from 79.0% in Bagmati to 95.6% in Sudurpashchim. Religious restrictions were the most prevalent (79.8%) followed by household level restrictions (39.5%) and thenChhaupadi(6.2%). Geographical variations were detected in all forms of menstrual restriction outcomes and were more prominent forChhaupadi. Individual level factors (age, sex, ethnicity/caste), household level factors (household wealth, age and sex of the household head) and regional factors (province) were significantly associated with at least one form of menstrual restriction outcome. Strikingly, women who reside in households led by female household heads were less likely to report experiencing household level restriction during menstruation (Adjusted prevalence ratio (aPR) =0.89 [95%CI: 0.84–0.94], p<0.001) whilst those residing in wealthy households were associated with lower likelihood of experiencingChhaupadi(aPR =0.26 [95%CI: 0.17-0.39] among the richest).InterpretationWe observed geographical micro-variations in menstrual discriminatory practices in Nepal presenting an opportunity for targeted behavioral interventions. Women empowerment is a promising strategy in the fight against menstrual discrimination within the household. Therefore, community-based targeted interventions should be designed and tested to determine their utility againstChhaupadiin these settings.