Prevalence and factors associated with unmet need for menstrual hygiene management in six countries in Sub-Saharan Africa: a multilevel analysis

Abstract

Background: Menstruation is a normal biological process experienced by more than 300 million women globally daily. Women need clean menstrual absorbents that can be changed as often as needed in private and safe place with proper hygiene and disposal facilities. All these needs must be met throughout the duration of the menstrual cycle. Access to menstrual needs of women is important for their health, wellbeing, and human dignity. This study assessed the prevalence and factors associated with unmet need for menstrual hygiene management (MHM) in Ethiopia, Kenya, Uganda, Burkina Faso, Ghana, and Niger. Methods: We used data from the performance monitoring for action (PMA) surveys. We defined the unmet need for MHM as “lack of resources, facilities and supplies for MHM.” Sample characteristics were summarised using frequencies and percentages while prevalence was summarised using proportions and their respective confidence intervals (CI). Factors associated with unmet need for MHM were assessed using a multilevel logistic regression model. Results: In the six countries, majority of women were aged 20-34 years, were married, or cohabiting and had never given birth. The prevalence of unmet need for MHM was high among the uneducated and multiparous women, those who reused MHM materials, practiced open defaecation and lived in rural areas in all the six countries. The prevalence of unmet need for MHM was highest in Burkina Faso (74.8%) and lowest in Ghana (34.2). Age, education level, wealth status and marital status were significantly associated with unmet need for MHM. Reuse of MHM materials and open defaecation increased the odds of unmet need for MHM. Conclusion: More than half of women in five of the six countries have unmet need for MHM withodds of unmet need significantly higher among younger women, those with low wealth status, the unmarried, and those with poor access to sanitary facilities. This study highlights the state of period poverty in Sub-saharan Africa. Efforts to end period poverty should approach MHM needs as a unit as each need is insufficient on its own.