Six in Ten Women in Rural Indian District Lack Adequate Menstrual Health Knowledge

In a district tucked into the northern reaches of West Bengal, a quiet but consequential health gap has been laid bare. A cross-sectional survey of 403 women aged 15 to 49 years, conducted across all 12 community development blocks of Koch Bihar district, India, has found that only 39.5 percent of women possess adequate knowledge of menstrual hygiene, while a striking 60.5 percent fall into the inadequate category. The study, published in SN Social Sciences by geographers Tapan Kumar Das of Cooch Behar College and Swagata Karjee of Cooch Behar Panchanan Barma University, offers one of the most granular portraits to date of how menstrual health knowledge is distributed across a rural Indian district, and the picture it paints is one of deep, patterned inequality.

The research team designed the survey to move beyond simple prevalence figures. Each participant answered ten binary knowledge items covering fundamental aspects of menstruation and its hygienic management, and responses were scored and then classified as adequate or inadequate relative to the mean score of the sample. This approach allowed the investigators to translate a sensitive and often stigmatized topic into a quantifiable measure that could be analyzed statistically. Interviews were carried out in private settings to protect confidentiality, a methodological detail that matters enormously in research on menstruation, where social desirability bias can distort self-reported knowledge and practice.

To identify which factors genuinely predict adequate knowledge, the researchers turned to Firth penalized logistic regression, a statistical technique specifically designed for situations where outcomes are imbalanced or where certain categories contain few observations. In this study, the technique was essential because adequate knowledge was the minority outcome, and conventional logistic regression can produce unstable or biased estimates under such conditions. The method yields adjusted odds ratios with 95 percent confidence intervals, allowing the team to isolate the independent contribution of each socio-economic and demographic variable while holding the others constant.

The results were unambiguous. Women living in urban areas had 3.59 times higher odds of adequate menstrual knowledge compared with their rural counterparts, with a confidence interval running from 1.08 to 9.21. Women with higher education showed 3.42 times higher odds, with a confidence interval of 1.29 to 8.13. The strongest single predictor was wealth: women from rich households had 4.21 times higher odds of adequate knowledge, with a confidence interval spanning 1.74 to 9.91. Because these confidence intervals exclude unity, the associations are statistically significant, meaning they are unlikely to be artifacts of sampling variation.

These three findings, urban residence, higher education, and rich wealth status, form a coherent sociological story. Education transmits health literacy directly, but it also changes how women seek and evaluate information. Wealth determines whether a household can afford sanitary products, private washing facilities, and access to clinics and media. Urban residence concentrates all of these advantages geographically, placing women closer to schools, markets, health workers, and television and internet signals. The fact that wealth emerged as the strongest predictor suggests that economic empowerment may be a particularly powerful lever for improving menstrual health awareness, potentially even among women with limited formal schooling.

Beyond these headline predictors, the study documented significant disparities across a wider set of characteristics, including age, marital status, media exposure, and women’s autonomy. The role of autonomy is especially noteworthy. Women who exercise greater decision-making power within their households were more likely to hold adequate knowledge, a finding consistent with a broader literature linking women’s agency to health outcomes. Autonomy affects whether a woman can act on what she knows, purchasing products, seeking care, and discussing menstrual health openly rather than in whispers. Media exposure, meanwhile, functions as an informal educator, carrying public health messaging into households that formal schooling may have missed.

Perhaps the most visually compelling component of the study is its spatial analysis. The researchers mapped knowledge levels across the district’s 12 blocks, presenting the maps as descriptive visualizations of geographic variation. The maps revealed a clear gradient: inadequate knowledge clustered in the southern and western blocks of Koch Bihar, while the central regions showed comparatively better outcomes. This kind of spatial patterning is more than an illustration; it is an analytical finding in its own right. It suggests that the determinants of menstrual health knowledge are not randomly distributed but are embedded in local geographies of infrastructure, schooling, transport, and cultural norms that vary from block to block.

The public health implications of these findings are substantial. Inadequate menstrual hygiene knowledge is not merely an information deficit; it is a pathway to poor hygiene practices, which in turn are associated with adverse health outcomes including reproductive and urinary tract infections. International frameworks, including work promoted by UNICEF and by researchers advocating for menstrual hygiene management on the global agenda, have increasingly recognized menstruation as a matter of health, education, and dignity rather than a private inconvenience. When six in ten women in a district lack adequate knowledge, the consequences ripple outward: girls may miss school during their periods, women may resort to unhygienic materials, and silence around the topic perpetuates itself across generations.

The study’s authors argue that targeted interventions are essential, focusing on education, economic empowerment, media access, and region-specific strategies. The word targeted carries real weight here. A uniform district-wide campaign would spread resources thinly across areas with very different needs. The spatial findings point toward concentrating efforts in the southern and western blocks, where inadequate knowledge is most concentrated, while the regression findings suggest that programs should prioritize rural women, those with less education, and households with fewer economic resources. Combining the statistical and spatial results offers policymakers a two-dimensional map of vulnerability: who is most at risk and where they live.

Conducted with ethical approval from the Institutional Ethics Committee of Cooch Behar College and carried out under the standards of the Declaration of Helsinki, the study took particular care with its youngest participants. For adolescents aged 15 to 17, written informed consent was obtained from a parent or legal guardian alongside assent from the adolescent herself, and all participation was voluntary with the right to withdraw at any time. The research received no specific grant funding, and the authors declare no competing interests. As India continues to expand menstrual health programs, studies of this kind, rooted in local geography and rigorous statistics, demonstrate that closing the menstrual knowledge gap will require more than distributing products; it will require confronting the educational, economic, and spatial inequalities that keep six in ten women in the dark about their own bodies.

Subject of Research: Socio-economic and spatial determinants of menstrual hygiene knowledge among women in Koch Bihar district, India

Article Title: Understanding menstrual hygiene knowledge among women: a case study from Koch Bihar district, India

Article References: Das, T. K., & Karjee, S. (2026). Understanding menstrual hygiene knowledge among women: a case study from Koch Bihar district, India. SN Social Sciences, 6(10), Article 455. https://doi.org/10.1007/s43545-026-01746-5

Image Credits: AI Generated

DOI: 10.1007/s43545-026-01746-5

Keywords: menstrual hygiene, menstrual health, Koch Bihar, West Bengal, India, women's health, cross-sectional survey, Firth logistic regression, spatial analysis, health inequality, women's autonomy, public health