Abstract
<title>Abstract</title> <p>Background Menstrual hygiene management (MHM) is essential to women's health and dignity but remains inadequately addressed in many low-resource settings, where barriers such as limited access to sanitary materials, poor water and sanitation infrastructure, and persistent cultural taboos constrain women's practices. Evidence on MHM practices and their determinants among reproductive-age women in urban Ethiopia remains limited. Methods A community-based mixed-methods study was conducted in Gondar city, Northwest Ethiopia, from May 30 to June 30, 2025. The quantitative component used a cross-sectional design with 610 randomly selected women aged 15–49 years from ten kebeles; the qualitative component used a phenomenological approach comprising six in-depth interviews and two focus group discussions. The quantitative data were analyzed in SPSS version 27 via bivariable and multivariable logistic regression; the qualitative data were analyzed thematically via OpenCode 4.02. Results Overall, 51.3% (95% CI: 47.3–55.3%) of the participants practiced good menstrual hygiene. Good practices were significantly associated with higher maternal education (AOR = 2.80; 95% CI: 1.19–6.59), maternal employment (AOR = 6.99; 95% CI: 3.52–13.90), favorable attitudes (AOR = 5.03; 95% CI: 2.61–9.70), middle wealth status (AOR = 1.62; 95% CI: 1.04–2.53), and home ownership (AOR = 2.64; 95% CI: 1.25–5.55). Lack of formal education (AOR = 0.20; 95% CI: 0.08–0.51) and student status (AOR = 0.59; 95% CI: 0.35–0.97) were negatively associated. The qualitative findings identified unaffordable sanitary products, inadequate WASH facilities, limited privacy, cultural restrictions, and poor social support as key barriers, contributing to school/work absenteeism, emotional distress, and disrupted daily activities. Conclusions MHM practices among reproductive-aged women in Gondar remain suboptimal, shaped by intersecting educational, economic, and structural barriers. Strengthening WASH infrastructure, ensuring affordable sanitary product access, and fostering open dialog at home, school, and work are critical to improving MHM practices.</p>