BackgroundMenstrual hygiene management (MHM) remains a neglected concern in Togo, despite its critical importance for the education, health, and dignity of girls and women. Neglecting MHM directly impacts women's reproductive morbidities that may adversely affect fertility outcomes. However, there is limited literature on MHM practices in Togo and their impact on individual fertility.ObjectivesThe study aims to examine the (1) effects of structural determinants-namely WASH infrastructure, socio-economic disparities, and social norms on menstrual hygiene practices, and (2) causal effect of MHM on reproductive health outcome, measured in terms of fertility of Togolese women. Considering the endogeneity of MHM, we aim to provide evidence that the roles of WASH facilities, social norms, and socio-economic factors influence MHM and thereby linking it directly to fertility of women.DesignThe study uses secondary data from a cross sectional survey of nationally representative Multiple Indicator Cluster Survey (MICS6, 2017) for Togo.MethodsWe have used control function (CF) approach to address the endogeneity of MHM to estimate the causal inference of MHM on the fertility of ever-married women aged between 15-49 years in Togo. The source of endogeneity of MHM is explained through the channels of social exclusion-related unobservable, and availability of WASH facilities.ResultsThe access to WASH facilities improve the probability of MHM by 31-53 percentage points. Our study establishes the existence of a strong causal relationship between MHM and fertility rate, establishing the endogeneity of MHM. The fertility increases (4-5%) significantly for women who manage their menstrual hygiene.ConclusionEffective MHM is crucial for individual dignity, health, and well-being. Our study indicates that proper menstrual hygeine management has significantly affect the reproductive health of women measured in terms of fertility. To foster an enabling environment of MHM concerned, the study recommended a few public policy interventions.
Keywords: C3; I12; I19; Togo; control function approach; endogeneity; fertility rate; menstrual hygiene management.
Menstrual hygiene management remains a neglected concern in Togo. Neglecting menstrual hygiene directly impacts women’s reproductive health and is closely linked to gender equality and empowerment. However, there is limited literature on menstrual hygiene practices and their impact on fertility rates. Our study aims to fill this gap by providing evidence of the existence of a causal impact of self-reported menstrual hygiene management on the fertility rate of Togolese women. Using the Multiple Indicator Cluster Survey (MICS6) of Togo for 2017, our findings indicate the significance of access to water, hand-washing facilities, and cleaning supplies in improving menstrual hygiene management. Furthermore, we find that socioeconomic factors such as education level, family affluence, etc, influence women’s ability to manage their menstrual hygiene. Our study underscores the need for integrating menstrual hygiene into reproductive health policies and addressing key socio-economic and structural barriers that hinder proper menstrual hygiene management.