Overview of Commercial Sanitary Product Solutions
At IMHER, we believe that a greater array of choices for affordable menstrual management products can be more empowering for those who need them, and that empowering women is a worthy goal. We believe that the best menstrual products are those that are preferred by menstruators who have been educated in an unbiased manner about the full range of options and pros and cons associated with each of them. In other words, we do not see it as our role to pick favorites; rather our role is just to identify and analyze what exists, and what might on the horizon. With that in mind, we have done our best here to outline the dominant pros and cons of each type of commercial menstrual management option.
Conventional Disposable Pads
DESCRIPTION: These are the sanitary pads populating the shelves and bathroom cabinets of most developed nations, which will also remain in landfills for generations to come. Design and composition can vary, but sanitary pads are often highly absorbent and odor-resistant, with adhesive strips to attach to underwear. They can be placed in a purse, used, and thrown away after use, making them effective, convenient protection in many situations.
ADVANTAGES: Most tend to be highly effective at preventing leaks and odors, at least among well-made pads. Relatively low initial cost (although relatively high annual cost). On-the-go convenience. No need to keep and clean the pad afterwards. No need to air dry the product afterwards, which can present privacy challenges in some cultures. Fairly minimal instruction can allow safe product use.
DISADVANTAGES: Much higher annual cost than most reusable products. Some users develop rashes, especially in hot and humid areas and/or when pads are worn too long (sometimes done on purpose to try to reduce monthly pad costs.) Very high environmental impact; materials are often of unstated composition, with heavy chemical content, and can take decades to decompose, with unknown toxicity effects on the environment. Waste-management challenges tend to be magnified in low-income communities, where trash disposal options are limited. (In response, some point out that many other common products have the same negative effects, so why is it primarily women who are expected to compromise their own comfort and convenience in response to waste management challenges?) Most disposable pads cannot be burned, which is the preferred method of disposal in many low-income areas due to lack of public waste-management options and/or where concerns about the use of blood are prevalent (i.e., beliefs about the use of blood in black magic and equivalent practices.) Donated disposable products have the potential to increase demand for them in populations that do not have the ability to buy them again, which may lead to pads being worn longer than they should be, among other issues.
Biodegradable Disposable Pads
DESCRIPTION: At their best, biodegradable disposable products provide exactly the same experience to users as standard disposable pads; their key difference is that they have a less negative effect on the environment. Some disposable pads that have substantial biodegradable content – usually on the order of 75%-90% (typically with a non-biodegradable waterproof barrier) — are starting to sell well in lower-income countries, presumably because these products are now comfortable, leak-proof, and affordable enough to compete effectively with their less-environmentally sensitive disposable competitors. We are using the term “biodegradable” here as a “catch all term” to refer loosely to most environmentally-sensitive pads; however, in practice, pads can be biodegradable, compostable, organic, and/or safe for burning, and each designation offers different benefits. Regardless, additional information is needed to know how environmentally sensitive a specific product will be under normal conditions, and that information is rarely made available to consumers.
ADVANTAGES: Requires the same (minimal) level of education for safe use as regular disposable pads and offers the same conveniences while taking a much lesser toll on the environment.
DISADVANTAGES: Claims of environmental sensitivity are often based only on producer claims. Reliable tests to verify producer claims of environmental sensitivity are rarely conducted and/or made publicly available. Aside from environmental concerns, most of the downsides are shared by all disposable pads. Prices for compostable disposable pads used to be far higher than those of non-compostable pads. The price differential has since been dropping over time, but compostable pads still seem to be at least somewhat more expensive. The jury is still out as to whether/when a comparably effective and desirable pad that is 100% biodegradable can be produced.
Washable (Reusable) Pads
DESCRIPTION: An increasingly wide array of washable / reusable pads is being developed, with many designed specifically for use in low-income communities. Most are made out of cloth – some are sewn in factories, and some are sewn by local women and sold for a profit. The quality and effectiveness of reusable pads can vary considerably. Most pads snap together, around underwear, with snaps attached to the “wings”; however, there are other variations (some only attach to specific kinds of underwear with snaps, and at least one other type is designed to be worn without underwear.) Typically, 4-8 reusable pads are purchased for use by one user for 2-5 years of use before they cease to be effective and need to be replaced (claims as to lifespans vary by product.) Reusable pads typically need to be hand-washed with soap and warm water and need to be air and sun dried outside until they are completely dry. Many are made in bright colors designed to appeal to young girls, and some are packaged in “menstrual kits,” which often feature a colorful bag for storage, waterproof storage pouches, laundry detergent, and/or a washing bucket, in addition to the pads themselves.
ADVANTAGES: All reusable options have higher front-end costs than disposable pads, but most have substantially lower annual and lifetime costs than their disposable counterparts. They do have to be thrown away after several years of use; however, due partly to lower volume over time, they cause significantly less damage to the environment than non-biodegradable disposable pads.
DISADVANTAGES: While offering cost savings relative to disposable pads in the long run, the initial cost to purchase a full set of reusable pads can be too high for many girls and women living at sustenance levels. Reusable pads require a significant amount of effort to maintain (i.e., regular washing, drying outside, etc.) and involve less convenience in other ways (i.e., have to be carried home for washing after use) as compared to disposable pads. Some girls are reluctant to wash products containing their own menstrual blood, and many lack warm running water, soap, and/or non-food basins to do so effectively. Due to menstrual stigma, there is often a reluctance to dry pads outside in the sunlight due to privacy concerns, and lack of open-air drying can theoretically increase the presence of harmful bacteria on the pads Fairly substantial education is required to encourage product adoption and to instruct girls on how to care for their pads effectively. Given that traditional solutions have often involved cloth, reusable pads can sometimes feel like a “step backwards” to girls rather than “progress,” which they often associate with premium global brands of disposable pads. As with menstrual cups, some entrepreneurs report that obtaining shelf space for reusable pads can be a challenge, since a given user will need to buy replacements very infrequently.
DESCRIPTION: Like tampons, menstrual cups are inserted internally. Unlike tampons, they do not absorb blood; instead, they collect blood in a device usually made out of medical-grade silicon. Users dump the blood out several times throughout the day (where sanitary facilities do not permit full cleaning with soap and warm water, girls are often provided with a water bottle that they can use to quickly rinse it until more complete cleaning is possible.) Menstrual cups need to be cleaned in boiling water at least once per month.
ADVANTAGES: Menstrual cups are small and strong; claims are often made that they are usable for 5-10+ years, with minimal environmental impact. Menstrual cups generally have the lowest over-time cost of any commercial product; some cups have dropped to the $5-$8 range for lower-income markets, and with their long lifespan, they are extremely cost-effective. Menstrual cups require relatively little water usage as compared to washable pads.
DISADVANTAGES: As with tampons, Toxic Shock Syndrome is a risk; however, with few reported cases of TSS from menstrual cups to date, the risk seems mostly theoretical at this point. Menstrual cup usage benefits from a high degree of comfort with one’s body and menstrual blood that some women — perhaps especially tween and teen girls — can have challenges adapting to. While very cost-effective in the long run, the front-end costs of menstrual cups are still too high for many low-income individuals to make a purchase without assistance. Not all menstrual cups are comfortable for all women, which can make the front-end costs even more challenging for low-income women, since there can be no guarantee that they will want to continue using a given type of cup after purchase. Due to some cultural beliefs and educational challenges around virginity and hymens, concerns are sometimes expressed about allowing unmarried girls use menstrual cups. Considerable education (not just of girls, but also of their mothers) is often required to overcome cultural resistance to menstrual cups, and to make sure that they will be used and cleaned correctly. As with reusable pads, some entrepreneurs report that obtaining shelf space for menstrual cups can be a challenge, since a given user will need to buy one very infrequently.
DESCRIPTION: Period panties (or menstrual panties) essentially consist of a reusable pad that is fully integrated into underwear.
ADVANTAGES: Many girls in developing countries do not wear underwear. Because period panties integrate a pad into underwear created for that purpose, a lack of underwear does not prevent this product from being used. Otherwise, the advantages of period panties tend to be the same as those associated with reusable pads.
DISADVANTAGES: Period panties tend to be considerably more expensive per pair than reusable pads, due to much higher material, production, and delivery costs (and presumably also due to the need to stock different absorbency panties in a wide variety of different sizes.) Additionally, changing reusable panties can be more challenging than changing reusable pads, requiring a more complete change of clothes (which can be an extra challenge in dirty bathrooms, or in bathrooms lacking privacy.) Otherwise, period panties share most of the same challenges as reusable pads.
DESCRIPTION: A small product that is inserted inside the vagina to absorb menstrual blood, expanding and softening over the hours that it is used. Applicators for tampons are often made of hard plastic, which gets thrown away after a single use, although a few brands can be inserted with a finger. Tampons need to be removed and replaced several times throughout the day; failing to do so can incur significant health risks.
ADVANTAGES: Tampons tend to be very absorbent and effective, and are extremely common in the U.S., Canada, Australia, and Europe; they tend to be much less commonly used in Asia, Africa, and the Middle East. Tampons are usually considerably smaller than disposable pads, so tend to have less environmental impact; however, plastic applicators can change that comparison, so that can vary by brand. Along with menstrual cups, tampons tend to be the preferred option for swimming and other water sports while menstruating.
DISADVANTAGES: While rare, the health risk of Toxic Shock Syndrome increases with tampon use, especially under conditions of improper usage (i.e., more absorbency than is needed and/or when a given tampon is left in for too long.) As with menstrual cups, cultural beliefs around virginity, hymens, etc. can heavily discourage tampon use, especially among unmarried girls. In many countries, tampons, if available at all, are mainly available at high-end specialty stores aimed largely at expats and tourists.
DESCRIPTION: One menstrual management option available to some women—especially those with higher income in developed countries— is avoiding menstruation altogether. Usually through the use of birth control — either the I.U.D. with progesterone (i.e., the Mirena IUD) or through using some types of birth control pills (where placebo pills are skipped under a doctor’s advice) — some women choose to cease menstruation entirely. (See, for example, this report on the safety of this practice recently revised by the U.K.’s largest Sexual and Reproductive Health professional organization, the FSRH, and this reaction by some women to those guidelines.)
ADVANTAGES: Skipping periods can eliminate the need for menstrual products entirely, along with eliminating most or all menstrual pain, while likely causing the least environmental harm of all available menstrual management options.
DISADVANTAGES: Breakthrough bleeding or light periods can still occur at unpredictable intervals for some women, requiring some degree of menstrual management in some cases. Women who do not feel comfortable interfering with their monthly cycles will not view this as an option, nor it is it an option for women who cannot be on, or who do not want to be on, a hormone-based birth control method. Birth control pills are often not affordable or available to lower-income women, and many do not have access to medical professionals who consult with them about the viability of skipping particular days of pills. The Mirena IUD tends to be extremely expensive and is not always covered by health insurance plans; as such, it is not a likely candidate for menstrual management for many low-income populations.
Underwear-free reusable pads
Underwear can be costly. As such, many lower-income girls in some cultures do not wear underwear on a daily basis. Menstrual panties solve this problem, but still tend to be too expensive for low-income populations. Menstrual cups and tampons can be worn without underwear, but in terms of low-cost external solutions (i.e., pads), all disposable pads and most reusable pads are designed to be worn with, and attached to, underwear. As such, designs for washable pads that can be worn without panties can be a cost-efficient solution; there are few currently in existence, however (see, for example, the design of the pads for The MoonCatcher Project).
A significant challenge with reusable pads can be social taboos which discourage girls from drying their pads outside in the sunlight. This can be a problem anywhere, but it can be a particular problem in boarding school settings and in urban areas, where privacy for drying laundry is rare. Additionally, drying pads can be a challenge in rainy or humid weather. The problem is that failure to dry washable pads properly can cause the growth of potentially harmful bacteria.
Makers of reusable pads sometimes propose options to these challenges; however, safe alternatives to drying in the sunlight can depend on the exact composition of the pad, so are not generalizable across pads.
A pad dryer could potentially provide discreet drying option that could better deal with humid conditions. The Flo Tool Kit is the only commercial product we know of designed specifically for that purpose. While it was created specifically to meet the needs of low-income girls and women in the developing world, it remains to be seem as to whether it will get to a price point that is affordable enough for a low-income family to justify purchasing it for the benefits it provides.
While buyers in developed countries tend to be familiar with the presence of small machines for single-pad and single-tampon purchases in some public restrooms for women, the idea of buying a large supply of sanitary products from a vending machine is a mostly a newer concept. Especially where social taboos make pad purchases in stores more challenging and/or in countries where obtaining shelf placement for new products can be an costly problem for entrepreneurs, this concept has a good deal of promise. See, for example, this new vending machine project or this one, which are both in India.
Home delivery can also address embarrassment and shelf-access issues. See, for example, this sanitary pad home delivery service in Pakistan