Menstrual Hygiene and Disability in Nepal: An Analysis of the 2022 Demographic and Health Survey

Introduction: Studies have shown that people with disabilities struggle with managing their menstrual hygiene. This can be because of a lack of education materials designed to meet their needs, inaccessible sanitation facilities, inability to use the available menstrual products, or lack of adequate assistance from caregivers. In Nepal, menstruation and disability are both highly stigmatized, with taboos regarding menstrual periods including excluding women from a number of activities during their menstrual periods. Objective: This study uses data from the 2022 Demographic and Health Survey (DHS) in Nepal to analyze differences in menstruation knowledge, use of hygienic menstrual products, and menstrual activity exclusions on the basis of disability. Methods: The 2022 Nepal DHS uses the Washington Group Short Set on Functioning to collect disability data in a subset of the DHS sample. The Short Set Severity Category (SS-SC), which categorizes each respondent as having no, mild, moderate, or severe disability, was used as the measure of disability for these analyses as it is able to take into account the impacts of multiple disabilities on a person. Bivariate analysis was conducted using chi-squares to determine association between disabilities and menstrual health outcomes. Crude and adjusted logistic regression models were then developed to determine odds ratios for each outcome of interest. Results: No statistically significant associations were found between disability and any of the outcomes of interest in the bivariate analysis. Women with mild and moderate disabilities were found to have a significantly higher odds of using an unhygienic menstrual product in the crude regression model, but this significance was no longer found in the adjusted models. No other statistically significant differences were identified in the logistic regression analysis. Conclusion: While statistically significant differences on the basis of disability were not found regarding menstrual hygiene knowledge or exclusion experiences, this does not mean that there are no difference in menstrual experiences among menstruators with disabilities. Qualitative studies have reported menstruators with disabilities receive less education regarding menstruation, struggle with their menstrual hygiene due to infrastructural and physical limitations, and must deal with the dual taboo of menstruation and disability. Policies and programs regarding menstruation in Nepal have not been inclusive of people with disabilities, which needs to change to ensure positive menstrual and reproductive health for the whole population.