The environmental impact of menstruation - The Ugandan perspective

Environmentally (un)friendly menstruation

Menstruation is a natural process occurring monthly in healthy people with uteruses all over the world. It is estimated that a person will menstruate for approximately 1400 days in their life (1). This means that a single menstruator would use between 2 and 15 thousand pads and tampons, which are the most common products for managing menstruation, in their lifetime (2).

However, managing menstruation comes at an environmental cost. We know that a standard non-organic pad takes between 500 and 800 years to biodegrade, whereas cotton tampons, which could be considered a more environmentally-friendly alternative, take approximately six months to decompose. On top of that, these products contain large amounts of plastic in their packaging, making biodegradation more difficult and lengthy (2).

The popularity and long biodegradation process of menstrual products, added to their improper disposal, leads to tampons and pads ending up in oceans and on beaches (2), causing damage to marine life (3). In fact, sanitary and menstrual products are the fifth most common product found on beaches, more than both plastic bags and straws.

Fortunately, new environmentally-friendly alternatives in terms of production and disposal are becoming widely known and available to individuals around the world. Examples of these include menstrual cups, washable menstrual pads, and period panties, which can be reused for several menstrual cycles (4,5).

Why Uganda?

Although commercial single-use pads and other menstrual products are available in Uganda, they are often unaffordable, and therefore unobtainable, for many people in the country, particularly in rural communities (8).

Additionally, persistent myths, taboos, and misconceptions surrounding menstruation in Uganda (6) make people uncomfortable to discuss menstrual health and hygiene and women and girls’ needs related to its management (7). The silence around menstruation sometimes leads to poor menstrual hygiene practices, including the use of alternative solutions to absorb menstrual blood, such as clothes, toilet paper, leaves, banana fibres, or pieces of mattresses. These practices can result in health problems and further social stigma and shame due to smell and discomfort (7).

The Swedish Organization for Global Health (SOGH) and the Ugandan Development and Health Associates (UDHA) have long worked with communities in Maina parish, Uganda. Their work responds to communities’ needs and demands and involves participatory approaches and community engagement through community health workers. In 2019, SOGH and UDHA conducted a pilot study to gather baseline data on the menstrual health practices of women and girls in Maina. This pilot study confirmed the persistent taboo and stigma and a consequent lack of menstrual health products that are acceptable to women and girls. The aim of the project this report is contributing to is to develop and implement a sustainable and community-based project to improve menstrual health for all the women and girls living in these communities.

Preferences for eco-friendly options in Uganda

Single-use menstrual pads, although largely preferred by the local population - as shown in SOGH and UDHA’s pilot study - may not be the best solution for managing menstruation with dignity and in an environmentally-friendly manner.

Thus, new products and innovative solutions, such as menstrual cups, period pants and reusable pads could be considered as interesting alternatives. Indeed, menstrual cups have been found to be acceptable, hygienic and safe in similar settings in Uganda (9). The study showed that not only women were satisfied with menstrual cups but they also found them more comfortable and affordable than pads (9). However, using a menstrual cup comes with challenges in that private and hygienic spaces to empty and rinse the cup, access to clean water and soap, and safe storage are necessary conditions for its use. Similarly, even though menstrual cups can last for up to 10 years, they would have to be imported to Uganda as there are currently no local producers. Airfreight is currently a significant source of greenhouse gas emissions, and therefore the importation of these products could be environmentally unsustainable.

Although menstrual cups have been found to be acceptable in Uganda and other products such as reusable pads are produced locally, questions remain about their environmental impact and affordability for women and girls in the country. Therefore, we will assess the environmental impact of these products in Uganda, and we will try to estimate the yearly cost for an average menstruating person in the country.

References

1. Sumpter C, Torondel B. A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management. Plos one. 2013; 8(4): e62004.

2. Peberdy E, Jones A, Green D. A study into public awareness of the environmental impact of menstrual products and product choice. Sustainability. 2019;11(2):473.

3. The Chic Ecologist. The Environmental Impact of Everyday Things [Internet]. The Chic Ecologist [cited 2021 May 31]. Available from: https://www.thechicecologist.com/green-living/the-environmental-impact-of-everyday-things/

4. Ruby Cup. Frequently asked questions [Internet]. Ruby Cup; 2021 [cited 2021 May 31]. Available from: https://rubycup.com/pages/faqs

5. Pixie Cup. How to use and care for reusable menstrual pads [Internet]. Pixie Cup. [cited 2021 May 31]. Available from: https://www.pixiecup.com/blog/reusable-menstrual-pads/#:~:text=How%20long%20do%20reusable%20menstrual,cloth%20pads%20last%20even%20longer

6. UNFPA. An Innovative Solution for Menstrual Hygiene [Internet]. UNFPA; [cited 2021 May 31]. Available from: https://uganda.unfpa.org/en/news/innovative-solution-menstrual-hygiene

7. Elzy KE, Atuhairwe C, Alege JB, Akugizibwe P, Serugo I, Kiconco S, et al. Assessment of menstrual hygiene management among karamojong adolescent girls in Rupa sub-county, Moroto district. J Nurs Educ Pract. 2017;8(24).Available from: https://core.ac.uk/download/pdf/234640849.pdf

8. SNV. Study on menstrual management in Uganda [Internet]. The Netherlands Development Organization (SNV)/IRC International Water and Sanitation Center; 2012 [cited 2021 May 31]. Available from: https://menstrualhygieneday.org/wp-content/uploads/2016/12/Menstrual_Management_-study-report_Uganda.pdf

9. Tellier M, Hyttel M, Gad M (2012). Pilot study report, WoMena Ltd: Assessing acceptability and hygienic safety of menstrual cups as menstrual management method for vulnerable young women in Uganda Red Cross Society's Life Planning Skills Project. Kampala, Uganda. Available at: http://womena.dk/wp-content/uploads/2015/11/Menstrual-Cups-_-WoMena-_-Uganda-Pilot-Study-Report-Dec-2012-new-version.pdf

About the authors

Maëli van Waasdijk, researcher, is a first-year master’s student in Public Health Epidemiology at Karolinska Institutet. She has a background in medicine.

Maria Ignacia Garrido Rios, researcher, is a nurse with a passion for public and global health.

Katherine Rennie, editor, has just completed her master’s in Global Health at Karolinska Institutet. In September she will continue with her fourth year of Medicine studies at the University of Southampton, UK.

This blog post was prepared by members of the Polygeia Stockholm Branch.