Residence-based inequalities among women and girls aged 15-49 years using reusable and single-use menstrual materials in Ghana: a cross-sectional study.

Background: Menstrual health is a critical component of sexual and reproductive well-being, yet inequalities in access to appropriate menstrual materials persist, particularly in low- and middle-income countries (LMICs). In Ghana, national progress in menstrual material use has been reported, but residence-based disparities remain insufficiently examined. This study assessed trends and rural-urban inequalities in the use of reusable and single-use menstrual materials among women and girls aged 15-49 years in Ghana. Methods: A repeated cross-sectional design was employed using nationally representative data from the 2016 Performance Monitoring for Action (PMA) survey and the 2017/18 Multiple Indicator Cluster Survey (MICS). Analysis was conducted using the WHO Health Equity Assessment Toolkit (HEAT). Survey data were accessed from the WHO HEAT platform and managed in Microsoft Excel prior to upload. Results: Reusable menstrual material use remained unchanged at 12.6% between 2016 and 2018. Single-use materials predominated (85.8% in 2016; 85.3% in 2018). Rural reusable use (21.3%; 18.0%) substantially exceeded urban use (5.5%; 7.4%). The absolute rural-urban difference narrowed from -15.8% to -10.6% for reusable, and 16.7% to 11.0% for single-use materials. Conclusion: Substantial and persistent residence-based inequalities in menstrual material use exist in Ghana. The study does not advocate for reusable over single-use materials, but calls for expanding safe, informed material choice across residential settings. Equity-responsive policies addressing affordability, access, and WASH infrastructure are urgently needed.