Geographical disparity and socio-demographic correlates of menstrual absorbent use in India: A cross-sectional study of girls aged 15–24 years

[Display omitted] •Education, economic status, and mass media exposure are significant predictors for menstrual absorbents use.•Rural areas are 23.5% less likely to opt for menstrual protection than urban areas.•Geographical disparity is striking. 309 districts and 11 states and UTs have menstrual protection for girls below the national average.•The highest number of poor-performing districts are in U.P. (59), M.P. (47), Bihar (38), Assam (24), Rajasthan (23) and Odisha (20).•Access to affordable SNTs and awareness on the importance of using them is critical for policy. The study has twofold objectives: (1) to study the geographical differences in uptake and use of menstrual absorbents among girls aged 15–24 years in India; and (2) to identify the socio-demographic factors associated with usage of different types of menstrual absorbents. The study uses information from a nationally representative sample of 247,833 girls of 15–24 years collected in the fourth round of the National Family Health Survey (2015–2016) based on a multi-stage clustered random sampling design. The study used two-step statistical analyses: (1) bivariate and GIS-based mapping tools were used to show geographical and socio-economic variation in the use of menstrual absorbents; (2) Multinomial Logistic Regression (MLR) and Multiple Classification Analysis (MCA) models were used to identify the factors associated with usage of different type of menstrual absorbents among Indian girls. The results point to a substantial state-wide variation in the use of menstrual absorbents across India ranging from the highest in Mizoram (93.4%) to the lowest in Bihar (31%). District level variations are more striking. Adjusted percentages from the MLR model show that more girls in the southern Indian states, northeastern states, and union territories tend to exclusively use Sanitary Napkins and Tampons (hereafter SNTs) compared to the states in the northwest, central, and eastern regions of India. Besides, girls with a higher level of education (35.2%, p