Menstruation, a normal physiological function, requires the maintenance of hygiene to prevent infection, which may lead to complications like primary and secondary infertility. However, in some rural and urban, traditional settings, unhygienic practices are still common. To understand menstrual hygiene practices and their relationship to education and income levels in an urban community in Pakistan, we undertook a community-based study in Hyderabad from 2003 to 2005. We found that the majority of women used some kind of material to absorb menses (98.5%). Most used a washed plain cloth (70.4%); however, unsanitary practices (e.g., unclean cloth) were used by 16.3% and of those who washed the cloth, a large proportion (19.3%) did not dry the cloth in the sun, as is the best practice. Another hygienic practice, frequency of change of the menstrual material, averaged 2.5 ± 0.9 changes (mean ± SD) on the first day of menstruation to 0.6±0.9 change of material per day on the last days. Despite availability of bathing facilities for nearly all women, only 64.0% reported bathing during menstruation which could be associated with cultural believe system. Women with higher education were more likely to have hygienic practices than those with no formal education (use of unwashed cloth 12.7% for group with no education, vs. 23.7% for women with formal education, p = <0.0001); there was not a significant difference in menstrual management practices among the income levels, as measured in our study
