Introduction <p>Period poverty is a multidimensional public health crisis affecting approximately 1.9&#xa0;billion individuals globally, characterised by regional inequalities and inadequate access to essential menstrual absorbents and functional Water, Sanitation, and Hygiene (WASH) infrastructure. In Nigeria, socioeconomic and geographic disparities may exacerbate period poverty, particularly between rural and urban populations. However, nationally representative evidence on the magnitude and determinants of these inequalities remains limited. The primary aim of this study is to determine the current prevalence, rural-urban disparities, and intersecting structural determinants and inequalities of period poverty in Nigeria.</p> Methods <p>A cross-sectional analytical design was employed using a sample of 32,775 women from the 2024 NDHS. The primary outcome, period poverty, was operationalised as the use of improvised or traditional materials during the most recent menstrual cycle. Statistical analyses included Erreygers-corrected concentration indices to quantify wealth-related disparities and Wagstaff decomposition to evaluate the relative contributions of education, geography, and wealth to overall inequality. Multivariable logistic regression models were fitted to examine factors associated with period poverty, with results reported as Adjusted Odds Ratios (AORs) and 95% Confidence Intervals (CIs) in RStudio.</p> Results <p>The national prevalence of period poverty in Nigeria is 51.3%, escalating sharply to 72.1% in rural areas compared to 31.1% in urban centres. Educational attainment emerged as the most potent structural predictor; women with no formal education exhibited a ten-fold increase in the odds of period poverty nationally (AOR 10.57; 95% CI 8.73–12.8), with the risk doubling in rural contexts (AOR 20.60; 95% CI 15.1–28.2). Regional vulnerability was most pronounced in the Northwest, where rural dwellers were four times as likely to experience deprivation as those in the South (AOR 4.19; 95% CI 2.93–6.00). Additionally, rural residence independently increased the odds of period poverty by 36% (AOR 1.36; 95% CI 1.17–1.58), while the use of polluting cooking fuels (AOR 3.51; 95% CI 2.60–4.76) highlighted the intersection of menstrual health with broader energy poverty. Significant contributors to inequality were Educational Attainment (34.82%), Geographic Region (24.94%), Fuel Type and Energy (12.13%), Household Wealth Index (11.67%), Marital Status (8.85%), Residential Status (2.47%), Household Water Source (2.41%), Sex of Household Head (1.56%), Toilet Facility Access (1.14%).</p> Conclusion <p>Period poverty in Nigeria is a systemic issue driven by the convergence of low education, rurality, and geographic location. The Wagstaff decomposition confirms that education is the largest contributor to inequality, alongside household wealth. Moving forward, for government and policymakers, implementing public health strategies must prioritise educational equity and regional infrastructure, particularly in Northern rural clusters, to ensure that menstrual health is recognised as a fundamental component of human dignity and national development.</p>