<b>Advancing Menstrual Health Equity through Community-Based Education in Rural India</b>

Abstract Background: Adolescent girls in low- and middle-income countries face persistent challenges related to health, education, and socio-economic inequities, particularly in contexts marked by poverty and limited access to essential services. Menstrual hygiene management (MHM), gender-sensitive health education, and community support remain critical yet under-addressed factors affecting girls' well-being, school attendance, and empowerment. Understanding stakeholder perspectives is essential for informing targeted interventions. Methodology: This mixed-methods cross-sectional study involved 360 participants, including adolescent girls (n = 150), mothers/guardians (n = 60), male community members (n = 60), school teachers (n = 45), and community health workers (n = 45). Quantitative data were collected through structured questionnaires, while qualitative insights were obtained via focus group discussions and in-depth interviews. Descriptive statistics and thematic analysis were employed to analyze the data. Among the adolescent girls, the mean age was 14.9 years (SD = 1.8), and 72% reported living below the national poverty line. Results: Findings revealed significant gaps in menstrual health education, availability of sanitary materials, and emotional support for adolescent girls. Socio-cultural taboos and poverty were major barriers to effective MHM. Teachers and community health workers demonstrated moderate awareness but limited training to address these issues in schools. Stakeholders emphasized the need for integrated school-based health interventions and greater parental involvement. Conclusion: The study highlights the pressing need for comprehensive adolescent health programs that prioritize menstrual hygiene, psycho-social support, and gender-inclusive education. Multi-stakeholder collaboration, policy advocacy, and community engagement are vital for sustainable change. Addressing these gaps can contribute significantly to the educational retention, dignity, and empowerment of adolescent girls.