Heavy menstrual bleeding and association with menstruation-specific resources: A multinational cross-sectional study in low- and middle-income countries.

Heavy menstrual bleeding (HMB), clinically defined as excessive menstrual blood loss which interferes with a woman's physical, emotional, social, and/or material quality of life, is a highly prevalent yet understudied global health problem. This cross-sectional study examines associations between HMB and menstruation-related resources, to understand factors that may contribute to HMB. We conducted secondary analyses of household survey data collected from women in eight cities across five countries: Meherpur and Saidpur, Bangladesh; Narsapur, Tiruchirappalli, and Warangal, India; Dakar, Senegal; Kampala, Uganda; and Lusaka, Zambia. HMB was assessed using the clinically validated SAMANTA scale, and menstruation-specific resources were measured through validated scales for safety and security, privacy, financial assets, and time. We conducted regression analyses, controlling for demographic covariates and clustering, of associations between HMB and menstruation-specific resources. Among our analytic sample of 3962 participants, 44.7 % were categorized as experiencing HMB. Results indicated that financial dependence on others for menstruation-related expenses and limited control over time were significantly associated with higher prevalence of HMB. Specifically, each one-point increase in financial dependence was associated with a 9 % higher HMB prevalence (p = 0.008), while greater control over time was associated with a 20 % lower prevalence (p < 0.001). The use of menstrual materials not specifically designed for menstruation, such as cotton wool or toilet paper, was also significantly associated with higher HMB prevalence. These findings highlight the critical importance of control over menstruation-specific resources, particularly financial resources and time, as well as improved access to affordable and high-quality menstrual materials, for menstrual health in urban populations.