What explains the rural-urban gap in the use of hygienic methods of menstrual protection among Youth in the East Indian state of Bihar?

Background: Menstrual hygiene management has become a globally recognized public health issue. As evidenced by the National Family Health Survey-4 (NFHS-4), among the states in India, Bihar accounts for the lowest use of hygienic methods of menstrual protection among youth. Further, the use in rural areas of Bihar is substantially lower than in urban areas. Objectives: Therefore, using NFHS-4 data, this study endeavors to explore the socioeconomic and demographic factors in explaining the rural-urban gap in the use of hygienic methods of menstrual protection among youth in Bihar. Methodology: A logistic regression model is used to identify the socioeconomic and demographic determinants of the use of hygienic methods, and Fairlie's decomposition technique is employed to compute the rural-urban difference in the use, and then to decompose these differentials into their separate underlying factors. Results: Findings from logistic regression analysis reveal that women's education, household wealth, media exposure, use of toilet facility, and awareness of sexually transmitted infections (STIs) are the significant determinants influencing the use of hygienic methods of menstrual protection. Results from decomposition analysis indicate that while use of improved toilet facility and mass media exposure among youth reduce the rural-urban gap, the unequal distribution of women's educational qualification, wealth index, marital status, and awareness of STIs has tended to widen the gap. Conclusion: The findings suggest promotion of menstrual hygiene practices, enhancement of menstrual hygiene knowledge, opportunities for women's education, better sanitation practices, exposure of mass media, and economic incentives among youth in rural Bihar