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Sanitary Technology: Do modern methods better serve women?

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Modern technology to address the needs of women is being introduced in lower-income setting at a quickening pace. Our Innovation Index shows that technology can be adapted to low-resource settings to improve the quality of women’s lives. Curiously, modern technology and innovation has been slower to reach the far corners of the globe when it comes to a ubiquitous female phenomenon: menstruation.

This blog post explores the state of sanitary technology and considers whether or not modern sanitary products are appropriate in context.
In general,reusable cloth is the norm. If washed and dried correctly, cloth is no less hygienic than disposable sanitary pads. However, according to the School for Social Entrepreneurs in Australia, cultural norms often promote unhygienic practices such as leaving cloths to dry in a damp corner of the house, which can breed bacteria and put women at risk for genital tract infections (1). In addition, the cloth that is used is often made from rough material, resulting in rashes and sores.

In an attempt to address the hygienic concerns surrounding traditional sanitary practices as well as in an effort to promote increased school attendance among girls, there has been a push to introduce modern, disposable sanitary technologies in the lower-resource settings. The most significant example of this is Procter and Gamble’s Always brand 2007 campaign. This campaign, however, represents the dangers of introducing a seemingly benevolent technology without first considering issues of context and sustainability. Disposable pads can create a waste problem in communities without landfill or incineration capacity (each year, globally, more than 10 billion pads and tampons are tossed into landfills and sewage systems). This can be counterproductive because open landfills create health hazards, and open incineration of products containing plastics can create toxic air. Additionally, disposable pads are not sustainable.

Given the problems associated with the introduction of disposable sanitary technology, does modern, reusable sanitary technology hold promise for developing areas? The menstrual cup, a silicon bell-shaped cup, can be inserted into the vagina to collect menstrual blood. These cups can be washed with soap and water and reused for up to a decade, producing drastically less waste than modern disposable sanitary products.
In contrast to campaigns for disposable sanitary products, there has been a much more intentional consideration of context in terms of how appropriate menstrual cups really are in low-resource areas. This is can be credited in large part to major menstrual cup manufacturing companies. DivaCup and Mooncup are the major brands of menstrual cup, and both manufacturers have been active in considering the applicability of menstrual cups to low-resource setting. For instance, the DivaCup website notes that religious and social mores in some areas may prohibit the use of internal feminine hygiene protection. In addition, DivaCup stresses that proper use of the cup requires mild soap and potable water—a luxury that many communities lack—and that improper use of the cup among women in low-resource areas could increase the incidence of gynecological infection.

Finally, DivaCup notes that the use of menstrual cups requires instruction. If women are not able to read and understand the instruction guide, the introduction of menstrual cups would require instruction and counsel from local health workers. The winter 2005/2006 Mooncup newsletter raises important questions: “how do we determine whether the same unsanitary conditions that create infections from the use of cloths will not also mean that maintaining the hygiene of a Mooncup is unrealistic? Even if water is available for boiling, how do we ensure that the correct methods of use and cleaning are communicated to these women in the first place?” This reflects a consideration of context and potentially adverse consequences of modern sanitation technology that is largely absent from the dialogue surrounding modern disposable sanitary products.

While cultural taboos, water sanitation issues, and language barriers certainly create obstacles for the uptake of menstrual cups throughout the developing world, studies are currently investigating the feasibility and potential impact of menstrual cups in low-resources areas. A randomized controlled trial in Nepal by Oster and Thornton using the Mooncup brand of menstrual cups showed fast adoption rates, significant time-saving benefits of the menstrual cups (22 minutes saved on laundry per period day!), and widespread satisfaction with the cups; in fact, most girls in the study expressed a (hypothetical) willingness to pay for menstrual cups. In this study of 198 girls, peer effects were seen in successful usage of the cup.

The African Population and Health Research Center (APHRC) is currently conducting a menstrual cup pilot study among girls in the Korogocho slums of Nairobi. The study will investigate both acceptability of the cups and whether or not the cup introduces infections.

We will continue to follow the story of these technologies, their adoption and the efficacy of competing technologies. And what about the question, if you had a dollar to spend on adolescent girls, where would it be best spent-- contraception? sanitary pads? education? oxytoxics to prevent hemorrhage?

Thanks to Elizabeth Adler for research and writing.
Photo by Krishna Ghimire.

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