The research, conducted by Susanta Sen, Asif Ali, Amit Banerjee, and Namita Chakma of the Department of Geography at The University of Burdwan in West Bengal, drew on two rounds of India’s National Family Health Survey: the fourth round, conducted in 2015–16 with 122,955 women, and the fifth round, conducted in 2019–21 with 118,700 women. The analysis focused on women aged 20 to 24 years, the standard age group used to assess child marriage prevalence under international indicators, since these women had passed beyond the age at which a legal marriage before 18 could have occurred. By comparing the two survey rounds, the researchers were able to track both the level of child marriage and the distribution of that practice across the wealth spectrum over roughly a five-year interval.

To measure inequality rigorously, the team employed the Erreygers Concentration Index, a widely used summary measure in health equity research that captures whether a health or social outcome is systematically concentrated among richer or poorer groups. A negative value of the index indicates that the outcome is concentrated among the economically disadvantaged. In both survey rounds, the Erreygers Concentration Index for child marriage was negative and statistically significant, confirming that the burden of marrying before 18 falls disproportionately on girls from poorer households. The index moved from −0.281, with a 95 percent confidence interval of −0.289 to −0.273, in the fourth round to −0.257, with a 95 percent confidence interval of −0.265 to −0.249, in the fifth round, indicating a modest narrowing of wealth-related inequality but no fundamental change in its direction or magnitude.

The absolute picture tells a similarly nuanced story. The absolute gap in child marriage prevalence between the poorest and richest groups narrowed from 20.65 percentage points in NFHS-4 to 19.04 percentage points in NFHS-5. Yet the relative measure moved in the opposite direction: the ratio of child marriage prevalence among the poor compared with the non-poor actually increased, from 2.07 to 2.20. This combination of a shrinking absolute gap and a widening relative gap is a classic pattern in epidemiology and social statistics, arising when prevalence declines faster in absolute terms among groups that already have lower baseline levels. In practical terms, even though fewer girls overall are marrying as children, a girl born into a poor household today remains substantially more exposed to the risk of early marriage than one born into affluence, and in relative terms that exposure has grown.

Beyond describing the inequality, the study’s central methodological contribution lies in its use of regression-based decomposition analysis, a technique that partitions the observed concentration index into contributions attributable to individual socio-demographic characteristics. Rather than simply noting that child marriage correlates with poverty, decomposition analysis quantifies how much of the measured inequality each factor statistically explains. The results were striking in their consistency: educational attainment dominated the explained component of wealth-related inequality in both survey rounds, accounting for 77.06 percent in NFHS-4 and 77.41 percent in NFHS-5. In other words, differences in schooling levels between rich and poor women are by far the largest statistical driver of why early marriage clusters among the disadvantaged.

The composition of the remaining explained inequality shifted over time in ways that offer clues about the changing social landscape. In the fourth survey round, place of residence, meaning the divide between urban and rural areas, was the second-largest contributor to wealth-related inequality in child marriage. By the fifth round, however, the contribution of mass media exposure had risen substantially, overtaking residential location as a key explanatory factor. This shift suggests that access to information, whether through television, radio, newspapers, or increasingly digital channels, has become a more salient axis of inequality as connectivity spreads unevenly across Indian society. It also implies that the messages, norms, and alternatives that media exposure conveys about marriage, gender roles, and women’s life courses play a measurable role in shaping when and whether girls marry.

The study also documented substantial variation across India’s states and Union Territories, underscoring that child marriage is not a uniform national phenomenon but one embedded in highly diverse regional contexts of culture, economy, and policy implementation. States differ enormously in baseline prevalence, in the steepness of the wealth gradient, and in the pace of change between the two survey rounds. This heterogeneity means that a single national policy lever, applied uniformly, is unlikely to produce equitable results. Regions where the wealth gradient is steepest may require intensively targeted approaches, while regions with lower but persistent prevalence may benefit more from broad norm-change campaigns and enforcement of existing legal prohibitions on marriage below the age of 18.

The public health significance of these findings extends well beyond the institution of marriage itself. Child marriage is internationally recognized as a driver of adverse outcomes including early pregnancy, elevated maternal and infant mortality risks, interrupted schooling, restricted economic agency, and increased vulnerability to domestic violence. When the burden of child marriage concentrates among the poorest girls, it functions as a mechanism through which poverty and disadvantage reproduce themselves across generations. The study’s conclusion that reductions in overall prevalence have not been matched by equivalent reductions in socioeconomic inequality echoes a broader theme in development research: aggregate progress can mask persistent, and sometimes widening, disparities that demand explicit equity-oriented policy attention.

The authors point toward a set of policy directions grounded in their decomposition results. Because education explains such an overwhelming share of the inequality, interventions that support girls’ secondary education, reduce the economic pressures that push families to withdraw daughters from school, and keep adolescents enrolled through the years when marriage decisions are typically made stand out as the highest-leverage options. The growing contribution of mass media exposure suggests that improving access to information, and using media channels deliberately to shift social norms around early marriage, could complement educational investments. The researchers also highlight strengthening social protection for economically disadvantaged households and explicitly prioritizing the poorest families in programmatic targeting, since the data confirm that the risk of child marriage remains most intense at the bottom of the wealth distribution.

Ultimately, the study delivers a message that is both encouraging and cautionary. India has made genuine progress: child marriage prevalence declined measurably between 2015–16 and 2019–21, and the concentration index softened slightly. But the persistence of a large absolute wealth gap, the rise in the poor-to-non-poor prevalence ratio, and the stark regional differences all indicate that the finish line remains distant for the girls whom the practice continues to touch most directly. As India and the global community pursue the elimination of child marriage under international development goals, this research argues that success should be judged not only by how far national averages fall, but by how quickly the gap closes for those at the bottom, where the consequences of marrying too young are felt most severely.

Subject of Research: Wealth-related socioeconomic inequality in child marriage among young women in India

Article Title: Wealth-related inequality in child marriage in India using decomposition analysis

Article References: Sen, S., Ali, A., Banerjee, A., & Chakma, N. (2026). Wealth-related inequality in child marriage in India using decomposition analysis. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00488-2

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00488-2

Keywords: child marriage, India, wealth inequality, Erreygers Concentration Index, decomposition analysis, National Family Health Survey, girls' education, mass media exposure, social protection, public health, NFHS-5, socioeconomic disparity

The study’s definition of exclusive hygienic practice was deliberately strict. A woman was counted as practicing exclusive menstrual hygiene only if she used sanitary napkins, locally prepared napkins, tampons, or menstrual cups without simultaneously resorting to unhygienic alternatives such as cloth, ash, or other improvised materials. This distinction matters because mixed use, in which a woman alternates between a sanitary pad and a piece of old cloth depending on availability or cost, is common in resource-poor settings and carries real health consequences, including elevated risks of reproductive and urinary tract infections. By measuring exclusive use rather than any use of hygienic products, the researchers captured a more demanding and arguably more meaningful standard of menstrual health.

The methodological architecture of the study combined three complementary analytical approaches. Descriptive statistics established the overall prevalence of exclusive hygienic practice and its breakdown across states. District-level spatial mapping then visualized the geographic distribution of the outcome, exposing patterns of concentration and clustering that state-level averages conceal. Finally, multivariable logistic regression isolated the independent associations between a suite of socio-economic, demographic, and household characteristics and the likelihood of exclusive hygienic practice, allowing the authors to estimate how each factor contributes while holding the others constant. This triangulation of statistical and spatial techniques is what gives the study its policy relevance: it identifies not only who is being left behind but where interventions should be concentrated.

The determinants the analysis uncovered follow a now-familiar gradient of privilege, but the magnitude of the effects among tribal women is striking. Higher education emerged as one of the strongest predictors, with women who had completed more years of schooling showing substantially greater odds of exclusive hygienic practice than those with little or no formal education. Household wealth exerted an equally powerful influence, reflecting the blunt reality that commercial sanitary products carry a recurring cost that poorer households struggle to absorb. Education likely operates through multiple channels simultaneously: better knowledge of menstrual health, greater bargaining power within the household, higher exposure to health messaging, and improved employment prospects that translate into personal spending capacity.

Age and residence patterned the outcome in opposite and instructive directions. Rural tribal women were less likely to use hygienic methods exclusively than their urban counterparts, a gap that points to the compounded burden of distance from markets, weaker supply chains for menstrual products, and limited privacy and sanitation infrastructure in village settings. Older women within the 15-to-24 age band also showed reduced odds compared with the youngest respondents, a finding the authors interpret as evidence of a generational shift: younger cohorts, exposed to school-based programs, media campaigns, and expanding product availability, appear to be adopting hygienic practices at higher rates than women just a few years their senior. Whether this cohort effect will translate into a population-wide improvement depends on whether supply and affordability keep pace with changing attitudes.

One of the study’s most policy-significant findings concerns sanitation. The availability of improved toilet facilities in the household was positively associated with exclusive hygienic menstrual practice, an association that survived statistical adjustment for wealth and other confounders. The link is intuitive when viewed through the lens of daily menstrual management: a private, safe, water-protected toilet changes what is practically possible during menstruation, enabling washing, secure storage of products, and dignified disposal. The finding suggests that sanitation programs and menstrual health programs are not parallel agendas but deeply intertwined ones, and that investments in household sanitation may deliver measurable co-benefits for menstrual hygiene among the most disadvantaged populations.

The spatial analysis is where the study delivers its most visually persuasive evidence. District-level maps revealed significant regional disparities, with lower odds of exclusive hygienic practice concentrated in central India, a belt that corresponds to many of the country’s predominantly tribal districts, and higher odds in the southern and western regions. Perhaps more important, the maps exposed substantial intra-state variation, meaning that districts within the same state often differed dramatically from one another. This heterogeneity is a direct challenge to uniform national strategies. A state-level average can mask districts where fewer than half of young tribal women use hygienic methods exclusively, and a national program calibrated to the average will inevitably overshoot some areas while leaving the worst-served districts untouched.

The implications for policy flow directly from the structure of the evidence. The authors argue that interventions must move beyond one-size-fits-all national programs and adopt region- and district-specific approaches that integrate multiple levers at once: expanding girls’ education, poverty alleviation, reproductive health awareness campaigns, and improved access to affordable menstrual products. Each lever maps onto a determinant the regression analysis identified. Education and wealth are long-term structural drivers that require sustained investment in schooling and social protection. Product access is a shorter-term supply-side problem that can be addressed through subsidized distribution, local manufacturing, and strengthening last-mile availability in rural and remote tribal areas. Sanitation investment, as the toilet-facility finding demonstrates, belongs squarely within this integrated package rather than being treated as a separate sectoral concern.

The concept of menstrual equity frames the study’s conclusions. Menstrual hygiene management has often been treated as a narrow technical problem solvable by product distribution alone, but the evidence assembled here situates it within a web of poverty, education, sanitation, geography, and social norms. Tribal women in India face compounded disadvantages on every one of these dimensions simultaneously, which helps explain why, despite measurable national progress in hygienic menstrual practice over recent decades, this population continues to lag behind. The 34.6 percent of young tribal women who lack exclusive access to hygienic methods represent not a residual problem but a concentrated one, clustered in identifiable districts and shaped by modifiable social conditions.

What the study ultimately offers is a map of accountability. By quantifying the prevalence, identifying the determinants, and visualizing the spatial clustering of unhygienic menstrual practice among young tribal women, the research converts a diffuse and often silenced public health concern into a set of concrete, locatable, and addressable deficits. The path forward it sketches is demanding, requiring coordination across education, health, sanitation, and social welfare sectors, calibrated to the district level rather than the national average. But it is also concrete. The data now exist to know where the gaps are, who falls into them, and which interventions are most likely to close them. Turning that knowledge into menstrual equity for India’s tribal women is the task the evidence has now made impossible to defer.

The analysis draws on the National Family Health Survey-5, India’s largest nationally representative household survey, which collects information on menstrual hygiene practices as part of its women’s health module. Because the survey covers the full country, it allows researchers to disaggregate findings down to the district level, a granularity rarely available for tribal populations, who are often too small a share of state or national samples to be studied separately. By restricting the sample to women aged 15 to 24 years, the study focuses on the age range in which menstrual practices are first established and in which school attendance, marriage, and childbearing decisions intersect with reproductive health.

India’s tribal communities, officially recognized as Scheduled Tribes, number more than one hundred million people and are concentrated in forested and hilly regions of central, eastern, and northeastern India. These areas historically have had lower coverage of health infrastructure, sanitation, and schooling than the rest of the country, and the central Indian belt identified in the spatial analysis overlaps substantially with this geography. The finding that improved toilet facilities were associated with hygienic practice is consistent with the broader observation that household sanitation shapes what women can do privately during menstruation, particularly in homes where water access and disposal systems are limited.

The emphasis on exclusive use also has implications for how progress is measured. If surveys count any use of a hygienic product as adequate, mixed practices that still expose women to infection risk go undetected, and the apparent gap between tribal and non-tribal populations may be understated. The strict definition adopted here therefore provides a more conservative and arguably more honest benchmark. The open-access nature of the article, published under a Creative Commons licence, means that the district-level evidence base it documents is available to program planners, state health departments, and civil society organizations working on menstrual health in the very regions the maps identify as underserved.

Subject of Research: Determinants and spatial patterns of hygienic menstrual practices among tribal women in India

Article Title: Determinants and spatial patterns of hygienic menstrual practices among tribal Women in India

Article References: Kumar, S., Dwivedi, S. N., & Reshmi, R. S. (2026). Determinants and spatial patterns of hygienic menstrual practices among tribal Women in India. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00435-1

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00435-1

Keywords: menstrual hygiene, tribal women, India, NFHS-5, spatial analysis, sanitation, menstrual equity, reproductive health, socio-economic inequality, public health, district-level mapping, logistic regression