The combined role of education and wealth in menstrual health: Evidence from Bangladesh

Background: Ensuring menstrual health remains a critical public health challenge, particularly in resource-limited settings. Both individual education and household wealth index are considered to play a crucial role in ensuring menstrual health. However, their interactive effect remains unclear, particularly in the context of Bangladesh. To address this gap, this study examines the interplay between education and wealth in determining the use of sanitary napkins in Bangladesh, with sanitary napkin use as a proxy for menstrual health. This choice reflects the predominant usage of sanitary napkins for menstrual management in Bangladesh. Methods: We used nationally representative data from the 2019 Bangladesh Multiple Indicator Cluster Survey (MICS). Sanitary napkin use by women during their last menstruation was used as the outcome variable. A generalized linear model with a logit link function was used to estimate adjusted odds ratios (AORs). Then using the fitted model, marginal probabilities of sanitary napkin use were estimated for subgroups defined by combinations of wealth index and educational attainment. Findings: The national prevalence of sanitary napkin use was 23.4%. Odds of sanitary napkin use was 4.5 times higher (AOR = 4.50, 95% CI: 3.28–6.16) among women with secondary or higher education compared to those with no formal education. Similarly, women from the upper three wealth quintiles had 2.3 times higher odds (AOR = 2.30, 95% CI: 1.58–3.34) of using sanitary napkins compared to those in the lowest two quintiles. Women with secondary or higher education from lower wealth quintiles were more likely to use sanitary napkins than with pre-primary or no education from wealthier households (marginal probability: 15.46% vs 9.25%). Conclusion: Both education and wealth play a critical role in determining menstrual health among Bangladeshi women. While financial constraints remain a key barrier, the findings suggest that improving individual education could significantly enhance hygienic menstrual practices, even among lower-socioeconomic groups. Policies should prioritize interventions for improving individual education for better menstrual health.