Systematic Review on Sanitary Pads and Female Health

Addressing the commercial determinants of menstrual health: a call to regulate menstrual product manufacturers

Over the last two decades, menstrual health and hygiene have become increasingly common on the global health agenda. While governments and international organizations are adopting measures to make menstrual products more accessible, corporate actors producing them have only been subject to limited scrutiny. Yet, their products and commercial practices raise environmental, health, equity and societal issues, which warrant attention and regulation. As such, commercial disposable menstrual products are largely made up of plastic, sometimes as much as 90%. Menstrual pads and tampons also contain some chemicals, the health impact of which is still unclear. In addition, these products are often sold with high-profit margins, and marketing campaigns to sell such products tend to reinforce shame and secrecy. So far, no global standards exist to regulate menstrual products and manufacturers, and evidence in the field of menstrual health and hygiene is lagging behind. To fill this gap, countries have started to regulate menstrual products and the International Standards Organization is in the process of developing global standards to better regulate the content and labeling of menstrual products. To support the emergence of regulation in this area, this article conceptualizes for the first time a comprehensive framework for the regulation of menstrual product manufacturers. This framework encompasses five complementary measures to regulate the content; labeling; production and waste management; pricing; advertising and marketing of menstrual products. The article also calls for more research to produce evidence and for increased governmental and inter-governmental attention to menstrual product manufacturers.

The condition of women frequently changing sanitary pads in 28 cities of China: a cross-sectional study

OBJECTIVES

This study aims to fill the gap in understanding the frequency of changing sanitary pads and the key factors associated with this practice among women in China.

METHODS

Using a convenient sampling approach, a cross-sectional study was conducted with a quota sampling method to survey women from 28 cities in China between October 21 and 31, 2020. Basic demographic characteristics, personal hygiene habits, self-efficacy, health-related quality of life, and disease status were collected. Multiple logistic regression model was used to analyze the factors associated with the frequency of changing sanitary pads.

RESULTS

A total of 1682 respondents were included in this study. The condition of frequently changing sanitary pads was divided into three groups: "Not taken" (224 respondents, 13.32%), "Short-term taken" (330 respondents, 19.62%), and "Long-term taken" (1128 respondents, 67.06%). Multiple logistic analysis revealed that women who performed "long-term taken" cleaning up rubbish timely (OR = 22.89, P < 0.05), "long-term taken" regular breast self-examination (OR = 19.46, P < 0.05), "long-term taken" actively obtaining scientific contraception methods (OR = 7.40, P < 0.05), as well as those with higher health-related quality of life (OR = 33.72, P < 0.05), were more likely to perform "long-term taken" frequently changing sanitary pads. Conversely, women with chronic diseases (OR = 0.48, P < 0.05) and those aged 31-40 (OR = 0.44, P < 0.05) were less likely to perform the "long-term taken" frequently changing sanitary pads during menstruation.

CONCLUSIONS

Most Chinese women practice good menstrual health management and frequently change their sanitary pads. However, there are still some women whose sanitary pad changing practices fall short of expectations. Multiple factors have been found to be associated with the frequency of changing sanitary pads. Based on the research results, healthcare institutions, schools, and the government can more effectively screen, assess, and support women who face menstrual health issues, thereby improving the overall level of menstrual hygiene management.

Resource recovery from soiled sanitary napkin waste-a state-of-the-art review

With ever-improving social and medical awareness about menstrual hygiene in India, the demand for sanitary napkins has increased significantly. The utilization of high-quality and environment-friendly raw materials to produce these pads is further supporting the growth of the market. However, with improving demand and usage, the need for proper disposal techniques becomes more relevant, since all of these pads get contaminated with human blood which makes them a biohazard and can cause significant damage to human health and the environment. One sanitary pad takes around 800 years to degrade naturally and the plastic and super absorbent polymers (SAPs) in sanitary pads are non-biodegradable and can take multiple decades to degrade. Waste management technologies such as pyrolysis, gasification, and resource recovery can be adopted to manage tons of sanitary waste. Currently, sanitary waste treatment mainly focuses on landfilling, incineration, and composting, where biohazard wastes are mixed with tons of solid waste. Disposable sanitary pads have a high carbon footprint of about 5.3 kg CO2 equivalent every year. Innovative solutions for sanitary pad disposal are discussed in the manuscript which includes repurposing of derived waste cellulose and plastic fraction into value-added products. Future aspects of disinfection strategies and value addition to waste cellulose recovered from napkins were systematically discussed to promote a circular economy.

Menstrual cup webinar series: A developing model of modified pre- and post-tests in the online teaching-learning of primary health care workers

Menstrual hygiene management, especially in resource-limited settings, is challenging. The acceptability of the menstrual cup is increasing recently in western countries whereas, in developing countries like India, the awareness, acceptability, and use of menstrual cups are very limited. We assessed the effectiveness of modified pre-post-test teaching-learning methodology in an online webinar series on menstrual cups using Moore's outcome assessment. An online webinar series on menstrual hygiene and the menstrual cup was conducted to raise awareness about the usage of menstrual cups among the health care workers like Auxiliary Nurse Midwife (ANMs), Accredited Social Health Activist (ASHAs), and Anganwadi Workers (AWWs) of the Guntur district, Andhra Pradesh, India. The questions of modified pre- and post-test were displayed. The questions were displayed to participants using the polling option in zoom. A total of 1597 health care workers participated in the menstrual cup webinar series. Of the total, 72.7% of participants responded to the job title question of which ASHA, ANMs, and AWWs were 16.8%, 34.2%, and 41.9%, respectively. The baseline knowledge of menstrual cups among primary health care workers for "heard of the menstrual cup" and "ever used/know anyone using menstrual cup" was 36.89% and 11.67%, respectively. After the webinar among the primary health care workers, the maximum gain in knowledge was seen for "menstrual cup can be cleaned in the home," 94.53%, and the minimum gain in knowledge was on "unmarried girls can use menstrual cups," 50.42%. The modified pre- and post-test model predicted an overall 50 percent rise in the knowledge of primary health care workers by the webinar series about a different aspect of the menstrual cup.As online webinar providers aim to provide more performance-based learning activities, current approaches to continuing medical education may become obsolete. The single most essential shift in online webinar planners can make is to incorporate modified pre-and post-test to allow for interactive and formative assessment during webinar activities.

A novel banana fiber pad for menstrual hygiene in India: a feasibility and acceptability study

BACKGROUND

Menstrual hygiene products used by women have evolved in the past several decades with comfort, ease of use and cost driving women's choices. In a country like India, where women form nearly 50% of the population, the sheer volume of periodic menstrual non-biodegradable waste generated has significant environmental implications. With majority of the country hailing from low-middle class backgrounds, observing healthy menstrual hygiene practices with environmentally friendly products necessitates the consideration of affordable and highly sustainable alternatives. Further, during the COVID-19 pandemic, period poverty is higher than ever, causing women to turn to the reusable product market for affordable and long lasting alternatives. Hence, we studied the Feasibility and Acceptability (FA) of a novel banana fiber based menstrual pad (BFP) amongst women living in rural and urban environments.

METHODS

The quantitative study of FA of the BFP was conducted amongst 155 rural and 216 urban participants in India. For greater authenticity of the FA study, we considered participants who used BFP for more than 4 months (Rural = 111 and Urban = 186) in the study. The survey data included responses from participants from Bihar, Delhi, Karnataka, Kerala, Maharashtra, Tamil Nadu and West Bengal. A 22-item survey instrument was developed and validated using Exploratory Factor Analysis (EFA) and reliability test (Cronback's [Formula: see text]). Binomial logistic regression analysis was used to analyse the factors that affect the FA of BFP based on the survey responses. In addition to survey analysis, environmental sustainability through [Formula: see text] footprint analysis, microbial load, pH and the ability of the BFP to withstand pressure after absorption were also studied.

RESULTS

The results indicated high levels of feasibility (rural [Formula: see text], urban [Formula: see text] and acceptability (rural [Formula: see text], urban [Formula: see text]) of BFPs across both participant groups. Comparing key BFP characteristics such as leakage and comfort to participants' prior practices revealed general satisfaction on the performance of BFP, leading to them recommending BFPs to others. User perception on the reasons for their preference of BFP highlighted their concern for environment, health and cost as decisive factors. The microbial load on a 3 year reused BFP was found to be similar to an unused BFP. Regression analysis showed cost as an important indicator for feasibility ([Formula: see text]; 95% CI = 1.083-3.248) and acceptability ([Formula: see text]; 95% CI = 1.203-3.748) amongst rural participants.

CONCLUSION

Based on feasibility and acceptability results, BFP is a promising consideration as an environmentally sound, non-invasive; yet reusable alternative to fulfil MHM needs in populous countries such as India. Longer term studies in larger samples are necessary to validate these findings.