Knowledge, economic, and WASH challenges affecting menstrual health and hygiene among nursing students in Bangladesh using a mixed-methods approach

Menstrual health and hygiene (MHH) remain stigmatized and neglected in low- and middle-income countries such as Bangladesh due to cultural taboos, poor infrastructure, and limited education. This study examines how knowledge, socioeconomic background, and WASH facilities are associated with key MHH indicators. A convergent mixed-methods design was applied between December 2024 and January 2025, combining a survey of 370 students from seven public nursing institutions with six focus group discussions involving 21 female and 21 male students for gendered understanding. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression, while qualitative data were examined through thematic analysis. Quantitative results showed that adequate access to menstrual products was associated with higher odds among students enrolled in the B.Sc. in Nursing program (AOR = 6.91, 95% CI 2.44–19.55, p < 0.05), as well as among students whose mothers had secondary education (AOR = 4.82, 95% CI 1.52–15.28, p < 0.05). Adequate WASH facilities were also associated with higher odds among students in the B.Sc. in Midwifery (Post Basic) program (AOR = 2.87, 95% CI 1.28–6.43, p < 0.05) and those whose mothers had higher secondary education (AOR = 6.19, 95% CI 1.47–26.00, p < 0.05). Qualitative findings revealed limited menstrual knowledge prior to menarche, embarrassment in purchasing products, unmanaged menstrual pain, and inadequate privacy and disposal facilities within campuses. Male students reported minimal formal exposure to menstrual education but demonstrated increased awareness of menstrual pain, privacy needs, and disposal challenges after engaging in shared academic and residential environments. This study is novel in integrating male student perspectives with institutional WASH constraints in nursing education, positioning menstruation as both a gendered and systems-level issue. The findings support actionable recommendations for gender-inclusive MHH curricula, minimum WASH standards in educational institutions, and policy alignment between nursing education, sanitation infrastructure, and menstrual waste management to promote menstrual dignity and equitable health training.