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Which, and how many, menstrual products are used? What is their content?
We focus on commercially available, disposable products such as pads and tampons, as well as reusable products such as washable cloth, pads or menstrual cups. We would have liked to add estimates for homemade or traditional products such as banana leaves, corn cobs, mattress stuffing. A common method of menstrual management in low-income countries is to use rags or cloths which are washed, and then dried in private places. Environmentally these require less to produce, but use more water. However, whereas some estimates are available in small-scale studies, we found little which could form the basis for national, or international estimates.These products are made from a mixture of materials, including cotton, rayon, polyester, and cellulose, fillers, and layer of plastic to prevent leakage. Some contain chemicals such as dioxins, containing chlorine and polythene that may produce dioxins furans, pesticide residues and fragrance chemicals. Biodegradable materials are estimated to take minimum 6 months to biodegrade; plastic up to several hundred years; for cups there is no estimate of how long they take to biodegrade, but menstruators will require only 4 in a lifetime.
Estimates for how many products are used per cycle differ widely. Approximately 25% of the world population are females aged 15-49 (UN, 2017), and that can also be used as a very rough estimate of the proportion of the population who menstruate (Tellier, 2018). One estimate from a high- income country is that a menstruator will use between 11,000 and 16,800 disposable menstrual products in a lifetime which is about 32 products each period. This translates into almost 200 kilograms of disposable products thrown away by a lifetime of menstruating (WEN, 2018). Similarly, Stein and Kim estimate that a menstruator will use between 12,000 and 15,000 tampons, pads and panty liners in a lifetime (Stein and Kim, 2009). However, estimates vary by level of income. We found no large-scales estimates for how many products menstruators use in Low Income countries, but menstruators in a country like Uganda often report using 10-20 products each period (Care international and WoMena Uganda, 2018). This would translate into 130-260 disposable products per year.
Globally, over 12 billion disposable menstrual products are used per year, filling up latrine or ending up in landfills. Disposable menstrual products also create approximately 6.3% of sewage-related debris along rivers and beaches. The bleaching chemical cocktail from most disposable menstrual products can have a detrimental impact on the environment. The disposable menstrual products often entail: the sourcing of raw materials, shipment to a manufacturing site and assembly/production, another round of transport for distribution and sale, use and then transported again for disposal. If incorrectly disposed, they may end up in the ocean which threaten marine life.
More recently, reusable menstrual products like menstrual cups, reusable pads, and absorbable underwear have increased in popularity because of their reusability, creating less overall waste, fewer chemicals used, and being less expensive. When comparing the environmental impact of different menstrual products, reusable products especially menstrual cups have the least environmental impact because of their durability (Weir, 2015).
What are current menstrual waste policies?
The safe disposal of used menstrual products places a burden on the user, sanitation systems, and the environment. A review of literature shows that menstrual waste management is not considered in the majority of Menstrual Health Management (MHM) and sanitation designs, leading to improper management at individual, community, and institutional levels. In addition, nations categorise menstrual waste differently, including ‘common household waste’,‘ hazardous household waste’, ‘biomedical waste’, or ‘plastic waste’ (Elledge, 2018; Campbell, 2018).
How do menstruators manage menstrual waste?
Menstruators generally dispose of used menstrual products in flush toilets, dustbins, open pits, latrines, or by burning or burying them (Elledge et al., 2018). The way menstruators manage may differ depending on whether they are at home or away. For example, they may use dustbins domestically, but in public places they may flush disposable pads down toilets, either because the bins are full, or dirty, or for fear of being observed. This behaviour has been observed in High, Middle, and Low Income Countries (Kaur, 2018; Kjellén et al., 2012; Elledge et al., 2018).
How does menstrual waste contribute to the problem of blockage of pipes?
Disposable menstrual pads and tampons made from super absorbent polymers (SAP) cause problems because they swell up once they are saturated with fluid and when flushed down the toilet can block pipes (Sommer et al., 2013; Elledge et al., 2018). Moreover, when disposed of, used menstrual products are often wrapped in plastic which further reduces decomposition. Even the products categorised as biodegradable accumulate in waste management systems (Borowski, 2011; Kjellén et al., 2012; Elledge et al., 2018). Sanitation systems are designed for urine and faeces. They are unable to break down solid menstrual products, which cause the sewage pipes to get clogged up and backflow (Kaur et al., 2018).
What is the financial cost of menstrual waste to the sanitation systems around the world?
Sanitation companies around the world report finding large quantities of menstrual waste in the material removed when unblocking pipes. For example in Sana’a, Yemen, the Water and Sanitation Local Corporation records about 1,200 sewage blockages each month, costing USD 24,000. Menstrual products are found in 80-90% of the cases. These problems are not limited to cities in low- and middle-income countries. In London, every year there are 55,000 blockages in the sewer network , at an annual cost of GBP 12 million, with used menstrual products in toilets a contributory factor. In pit latrines, once the sludge has been removed, disposable menstrual products must be extracted before the sludge can be composted or used for agriculture which adds to the cost, and is a source of disgust for sanitation workers (Kjellén et al., 2012).
Research in Scotland highlighted the considerable savings from even a 50% change in menstrual product disposal habits. A switch from disposing through the waterborne sewerage system to a solid waste route would mean savings for the water companies. Savings which would be to the direct benefit of the water companies and water authorities and ultimately passed on to customers (Ashley et al., 2005; Kjellén et al., 2012).
What is the environmental impact of disposable menstrual waste?
Studies suggest that disposable menstrual products based on rayon and cotton have an acidification and eutrophication environmental impacts, possibly the same impact as plastics (Weir, 2015). Furthermore, those commercial tampons and disposable pads which contain chlorine and polythene lead to the contamination of the environment, including the sea, groundwaters, and soils if burned (Elledge et al., 2018).
Are there any differences in environmental implications between different menstrual products and methods for disposal menstrual waste?
A study by Weir estimates that the Divacup (a brand of reusable menstrual cup) has the least amount of environmental effect compared to disposable products such as Tampax, Softcup (disposable menstrual cup), and ‘o.b.’ (a disposable tampon) (Weir, 2015). A global review depicted two harmful consequences of menstrual waste on the environment. One is the accumulation of used menstrual products in landfills, and second, the emission of toxic dioxins and other hazardous gases from incineration because of inadequate emission control measures or poor thermal treatment performance. Landfilling and incineration cause air pollution (Kjellén et al., 2012; Elledge et al., 2018). Even when biodegradable tampons are thrown in landfill due to lack of oxygen would not degrade. The polyester lining and the plastic applicator would also not degrade which in turn leach hormone-disrupting chemicals like bisphenol A into the environment (Davidson, 2012).
From an environmental perspective, reusable menstrual products such as the menstrual cup and reusable pads are more environmentally-friendly, though they require clean water for washing the product, and also hands and soiled underwear. For example, high quality reusable pads may result in less leakage than cloth. WoMena’s informal tests and reports indicate that menstrual cups require 1-2 litres of water each period, comparing to 15 litres for reusable pads and cloths (Elledge et al., 2018; CARE International and WoMena Uganda, 2018; Tellier, M.2015. Email to IRise).
What is being done?
In 2018, the European Commission announced that it would take action to tackle the ten plastic waste items most often found on Europe’s beaches. Among these, disposable menstrual products like tampons and pads, included under “wet wipes and sanitary items”, ranked 5th with total of 9,493 items found on Europe’s beaches (European Commision, 2018). The prediction is a total of that 252 million menstrual products will appear in marine litter in Europe’s beaches and seas by 2030 (European Commision, 2018).
The reason for this pollution lies mainly in improper waste disposal. Disposable menstrual pads, wet wipes and cotton bud sticks often end up in the ocean when they are flushed down the toilet, instead of being placed in a designated bin (European Commision, 2018).
Thus, with the aim of reducing the amount of plastic in the ocean, the European Commission has agreed on measures to limit production and consumption. The single-use plastic bags and cotton buds will be banned from the market. Menstrual products were labelled as “items with none or difficult alternatives”
(European Commission, 2018), so the European Commission recommends an awareness campaign through labelling.“Certain products will require a clear and standardised labelling which indicates how waste should be disposed, the negative environmental impact of the product, and the presence of plastic in the products. This will apply to sanitary towels, wet wipes and balloons” (European Commission, 2018). The European Commission treats this as a priority file and plans to take implementation measures in 2019.
Conclusions and recommendations:
Evidence is poor. However, there is good evidence that indicates significant environmental impact in key areas (e.g maritime pollution, sanitation systems).
There are also many knowledge and action gaps:
- There is a need for lawmakers to ensure full disclosure by companies of materials used in commercially available products, particularly materials which take long to biodegrade (e.g. plastics) or dangerous chemicals (e.g.chlorine and polythene) (Kjellén et al., 2012; Elledge et al., 2018; Kaur, 2018). This should include an assessment of the environmental lifecycle for each type of menstrual product include the environmental costs across all stages of production, distribution, use and disposal (Weir 2015).
- Materials should be further studied, in terms of potential environmental and health impact for users, sanitation workers who have long-term and cumulative exposure; postmarket surveillance to monitor product defects and health effects should be introduced (Bae et al., 2018).
- Help develop basis for clear categorisation and standardisation of menstrual products and waste, including performance, quality, health and environmental impact. Include reusable and biodegradable products (Sommer et al., 2013), develop standards which will help the introduction of such products (Elledge et al., 2018).
- In the design of sanitation systems (community and institutional), consult with users and sanitation workers, and study results in improving privacy, wellbeing, minimising environmental consequences (Kjellén et al., 2012; Elledge, 2018). Study the role of teachers in providing education to improve practice in disposal habits (Kaur, 2018).
- To the extent relevant and feasible, studies should also include ‘traditional’ products, since a large proportion of menstruators use such products.They cannot automatically be assumed to have no environmental impact.
 PMA2020 has useful estimates, but they are difficult to use in making national of global estimates, as they have little disaggregation by product, and at times have only subnational estimates (e.g. urban vs rural).
 A BBC news article claims that pads contain as much plastic as 4 supermarket bags, but we have so far been unable to find the original source for this.
 See also forthcoming WoMena FAQ on harmful substances
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WoMena, 2019. ‘’WoMena FAQ: Are there harmful substances in menstrual products.’’ (forthcoming)