colorful cups

Menstrual Cups: Life-Cycle Assessment

The Challenge

Menstrual hygiene products, such as tampons and pads, cost US consumers some $3.1 billion per year (Euromonitor, 2017). At the same time, 49.8 billion tampons and sanitary pads plus their packaging end up in landfills or sewer systems each year in the US, meaning that the economic and environmental cost of these products is high. Can the menstrual cup help solve both of these problems? Can a change in menstrual hygiene sanitation help achieve the United Nations' Sustainable Development goals #5 "gender equality" and #6 "clean water and sanitation" by the year 2030? Can we promote two social goods: both gender equality and environmental sustainability?

Method: Environmental Life-Cycle Assessment

Life-cycle assessments analyze the environmental impacts of a product throughout its life cycle from growing, extracting, and processing raw materials, manufacturing, transportation and distribution, and recycling or final disposal. Environmental sciences should develop comparative life-cycle assessments for each type of menstrual product. Manufacturers should provide assessment results on product labels, enabling consumers to consider environment costs in their decision making.

Gendered Innovations:

  • 1. Menstrual Cups are Good for the Environment
  • 2. Menstrual Cups are Good for Gender Equity
  • 3. Menstrual Cups are Good for Women's Health
  • 4. Menstrual Cups Help Keep Girls in School
Go to Full Case Study
The Challenge
Conclusions
 

The Challenge

Menstrual hygiene products, such as tampons and pads, cost U.S. consumers some $3.1 billion per year (Euromonitor, 2017). At the same time, 49.8 billion tampons and sanitary pads plus their packaging end up in landfills or sewer systems each year in the US, meaning that the cost of these products to consumers and to the environment is high. Can the menstrual cup help solve both of these problems? Can a change in menstrual hygiene sanitation help achieve the United Nations' Sustainable Development goals #5 "gender equality" and #6 "clean water and sanitation" by the year 2030? Can we promote two social goods: both gender equality and environmental sustainability?

menstrual cups from putacupinit

The gendered innovation here is the menstrual cup. Although originally patented in 1867 (US 70843 A) and again in 1932 and 1937, menstrual cups have only recently become popular.

A menstrual cup:

  • 1. is a bell-shaped and made of medical-grade silicone or natural latex. It is inserted into the vagina to collect (not absorb) menstrual fluid.
  • 2. can be left in place for up to 12 hours.
  • 3. may last for 2-4 years; some may last up to 10 years.
  • 4. is reusable. A user may need as few as 4 in a lifetime but is more likely to use some 32.
  • 5. must be washed between uses and be sterilized at the end of the period. Cups can be sterilized in boiling water, microwaves, or, when traveling, with sterilizing tablets.
  • 6. is not biodegradable but can be recycled at a specialty recycling center (Thiele, 2016).
  • 7. are multifunctional. They can deliver contraception, vaginal medication, and, when a microbicide is added, protect against STIs and HIV. They may also function as a fertility aid by retaining semen close to the cervix (North & Oldham, 2011).
  • 8. can be used by women and transmen. (N.B. Not all women menstruate/not all menstruaters are women. Transmen who menstruate also require effective products).
  • 9. cannot be used by people who have undergone genital cutting and been sewn closed—as is the case for 200 million girls and women worldwide (WHO, 2018).

N.B. Menstruation is a fact of life. We want to make clear that menstrual products constitute only a small proportion of waste created globally each year. The purpose of this case study is to encourage manufacturers to provide products that are safe and effective—from the point of view of environmental impact, cost, and health.

1: Menstrual Cups are Good for the Environment

Traditional hygiene products, such as tampons and pads, are a burden to the environment. Altogether a person who menstruates likely uses around 15,000 sanitary pads or napkins, creating some 250-300 pounds of waste, across a lifetime (Stein, 2009, 238).

potential global warming comparisons of cups vs other brands The figure (right) compares the environmental impacts of four products—o.b. tampons (non-reusable, no applicator), Tampax tampon (non-reusable, applicator), Softcup (non-reusable), and DivaCup (reu sable) as indexed by 'global warming potential'. Overall, reusable menstrual cups have the softest environmental touch (Weir, 2015).

This study also analyzed material impacts by abiotic depletion, fossil fuel depletion, acidification, eutrophication, and waste production. In each category, reusable menstrual cups were the most environmentally friendly.

These data, however, do not factor in all environmental costs across all stages of production, distribution, use, and disposal. What is needed is a life-cycle assessment for each product from raw material extraction, material production, parts production, and assembly to its use and final disposal. For example, cotton used in many tampons and napkins requires significant land use, water, and pesticides to grow.

The environmental impact of pads and tampons is growing. In India, for example, only 12% of the 335 million women currently use sanitary napkins (Geertz et al., 2016). What will happen when 100% of those in their reproductive years achieve sanitary protection across India, Africa, and China (the last of which currently manufactures 85 billion sanitary napkins each year—Yang, 2016)?

Some traditional sanitary products are biodegradable, but the vast majority are made from synthetic materials that decompose slowly. Some 90 percent of sanitary napkins are plastic (Women's Environmental Network, 2017). It is estimated that the 20 billion pads, tampons, and applicators accumulating in North American landfills every year will take 500 to 800 years to fully biodegrade (Geertz et al., 2016, 12).

2: Menstrual Cups are Good for Gender Equality

In 2015, U.S. consumers spent some $3.1 billion on tampons, pads, and other menstrual products (Euromonitor, 2017). Typically, tampons alone cost approximately $7/month (in 2015 dollars). The total cost for a lifetime's worth of tampons and pads is estimated at somewhere around $2,117 plus government taxes (BBC News, 2017).

This cost magnifies gender inequality given the gender pay gap (women in the US overall earn 80.5 cents on the dollar). These costs especially burden low-income people, creating a barrier to accessing menstrual sanitary products. US aid programs, such as Medicaid, do not support menstrual products, even though the FDA considers them medical devices (Kosin, J., 2018).

Although the cup is more expensive upfront (roughly U.S. $15-25 depending on the brand), because it is reusable it saves thousands of dollars over a lifetime. A conservative estimate would project the costs as low as US$180 for cups (assuming 3 cups per decade x 4 decades) and not more than $430 plus government tax (assuming 8 cups x 4 decades). The initial investment may be high because of the possible need to purchase several cups before finding the right fit.

3: Menstrual Cups are Good for Health

The US FDA recommends but does not require tampon and sanitary pad makers to disclose the materials and chemicals in their products (FDA, 2005). People may be unaware of potential toxins, in particular dioxin, contained in these products (WHO, 2016). Although the FDA considers the threat from dioxins in tampons "negligible," no studies have tested diffusion of dioxins from tampons in vivo or the accumulative impact of exposure over a lifetime (Weir, 2015; Dudley et al., 2018). Further, tampons and pads carry the threat of toxic shock syndrome (Wendee, 2014).

Menstrual cups by contrast are hypoallergenic and do not significantly support the growth of the bacterium S. aureus, associated with TSS (Tierno, 1994; North & Oldham, 2011).

4: Menstrual Cups Help Sustain School Attendance in Developing Countries

Menstrual hygiene products can be prohibitively expensive in low-income settings, such as parts of the U.S., sub-Saharan Africa, and rural India. As a result, people may use reusable cloth, newspaper, or simply stay home (Sommer & Sahin, 2013).

graph of Menstrual health around the world

A number of recent projects have studied the impact of introducing menstrual cups to school-age children in South Africa, Uganda, Kenya, and rural India. Participants were provided a cup, education on menstruation and cup use, and a bar of soap each month plus information on how to disinfect cups (although many lacked the simple equipment required to boil cups—Hyttel et al, 2017). Studies found that, with proper education and training, participants successfully used the cups, and often preferred them to pads (Howard et al., 2011; Beksinska et al., 2015; Mason et al., 2015).

Cups had several advantages: menstrual cups reduced fear of leaking, increased confidence, comfort, mobility, independence, and allowed active school attendance or work during menstruation. A cluster randomized control study in rural Western Kenya also found health benefits. Menstrual cups can also be used to deliver contraception, vaginal medication, and, when a microbicide is added, protection against STIs and HIV. (North & Oldham, 2011; Phillips-Howard et al., 2016).

The cost of any menstrual hygiene products is prohibitive in many areas. Some cup brands, such as Femmecup, Ruby Cup, Keeper, Diva cup, Lunette, Softcup, and My Own Cup, have programs to donate to people in need.

Conclusions

Menstruation is a fact of life. But the way societies manage and respond to menstruation can and are changing. Proper management requires changing attitudes and making menstruation a topic people feel comfortable talking about and taking action on. Education, support, and sanitation infrastructure are all important. The goal is comfortable, convenient products that are safe for people and the environment.

Next Steps

  • 1. For environmental sciences, comparative life-cycle assessment is required for each type of menstrual product. These analyses should factor in all environmental costs across all stages of production, distribution, use, and disposal. On packaging, manufacturers should provide results from such a life-cycle analysis for the specific product, indicating environmental impacts from raw material extraction, material production, parts production and transportation, and assembly to its use and final disposal.
  • 2. Product designers can provide alternatives to traditional menstrual hygiene products. Current initiatives:
  • 3. Politicians should support human rights with respect to menstruation. Human Rights Watch and WASH United have stated that the biological fact of menstruation, the necessity of managing menstruation, and society's response to both is linked to human rights and gender equality (Human Rights Watch, 2017). Chief of the UN Human Rights Office Economic and Social Issues Section, Jyoti Sanghera, adds that "stigma around menstruation and menstrual hygiene is a violation of several human rights" (UNOHCHR, 2014).
  • 4. Foundations can support access to sustainable menstruation products. The Bill and Melinda Gates Foundational, for example, advocates for addressing menstruation sustainably and at scale (Geertz et al, 2016). This includes safe and consistent access to products, supportive communities, education and awareness, and excellent sanitation facilities and services.

1 Calculated from 2010 U.S. Census and estimate of menstrual hygiene products used per year (between 195 for those with light days and 1000 for those with heavy days).



Works Cited

BBC News (2017). Tampon tax: How much have you spent? BBC News. http://www.bbc.com/news/health-42013239 Downloaded Feb 7, 2018.

Beksinska, M. E., Smit, J., Greener, R., Todd, C. S., Lee, M. L. T., Maphumulo, V., & Hoffmann, V. (2015). Acceptability and performance of the menstrual cup in South Africa: a randomized crossover trial comparing the menstrual cup to tampons or sanitary pads. Journal of Women's Health, 24(2), 151-158.

Dudley, S., Nassar, S., Hartman, E., & Wang, S. (2018). Tampon safety. National Center for Health Research. http://www.center4research.org/tampon-safety.

Euromonitor International. (2017). Sanitary Protection in the US.

Food and Drug Administration (FDA). (2005). Guidance for industry and FDA staff. Menstrual tampons and pads: Information for premarket notification submissions. U.S. Department of Health and Human Services.

Geertz, A., Iyer, I., Kasen, P., Mazzola, F., & Peterson, K. (2016). An Opportunity to Address Menstrual Health and Gender Equity. FSG.

Human Rights Watch (2017). Understanding Menstrual Hygiene Management & Human Rights. https://reliefweb.int/sites/reliefweb.int/files/resources/mhm_practitioner_guide_web.pdf

Howard, C., Rose, C. L., Trouton, K., Stamm, H., Marentette, D., Kirkpatrick, N., ... & Paget, J. (2011). FLOW (finding lasting options for women). Canadian Family Physician, 57(6), e208-e215.

Hyttel, M., Thomsen, C. F., Luff, B., Storrusten, H., Nyakato, V. N., & Tellier, M. (2017). Drivers and challenges to use of menstrual cups among schoolgirls in rural Uganda: a qualitative study. Waterlines, 36(2), 109-124.

Kosin, J. (2018, May 3) Getting Your Period Is Still Oppressive in the United States. Harper's Bazaar.

Mason, L., Laserson, K., Oruko, K., Nyothach, E., Alexander, K., Odhiambo, F., ... & Mohammed, A. (2015). Adolescent schoolgirls' experiences of menstrual cups and pads in rural western Kenya: a qualitative study. Waterlines, 34(1), 15-30.

North, B. B., & Oldham, M. J. (2011). Preclinical, clinical, and over-the-counter postmarketing experience with a new vaginal cup: menstrual collection. Journal of Women's Health, 20(2), 303-311.

Phillips-Howard, P. A., Nyothach, E., ter Kuile, F. O., Omoto, J., Wang, D., Zeh, C., ... & Eleveld, A. (2016). Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural western Kenya. BMJ open, 6(11), e013229.

Sommer, M., & Sahin, M. (2013). Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls. American journal of public health, 103(9), 1556-1559.

Stein, Elissa, and Susan Kim. (2009). Flow: The Cultural Story of Menstruation. St. Martin's Griffin.

Thiele, L. (2016). How to Recycle a Menstrual Cup. Ruby Cup. http://rubycup.com/blog/how-to-recycle-a-menstrual-cup/

Tierno, P., & Hanna, B. (1994). Propensity of tampons and barrier contraceptives to amplify staphylococcus aureus toxic shock syndrome toxin-i. Infectious Diseases in Obstetrics and Gynecology2, 140-45.

United Nations Human Rights Office of The High Commissioner (2014). Every woman's right to water, sanitation, and hygiene http://www.ohchr.org/EN/NewsEvents/Pages/Everywomansrighttowatersanitationandhygiene.aspx Retrieved February 21, 2018.

Weir, C.M (2015). In The Red: A private economic cost and qualitative analysis of environmental and health implications for five menstrual products. Environmental Science and Gender and Women Studies, Dalhousie University, Canada. Thesis supervised by Tarah Wright, Environmental Studies, and Peter Tyedmers, School of Resource and Environmental Studies, Dalhousie University.

Wendee, N. (2014). A question for women's health: Chemicals in feminine hygiene products and personal lubricants. Environmental Health Perspectives. 122, no. 3, A70.

Women's Environmental Network (2017). Periods are natural. Bleached plastic sanitary products aren't. https://www.wen.org.uk/environmenstrual/ Downloaded Feb 7, 2018.

World Health Organization (2018). Female genital mutilation: Fact sheet. http://www.who.int/mediacentre/factsheets/fs241/en/ Downloaded Feb 9, 2018.

World Health Organization. (2016). Dioxins and their effects on human health. Fact sheets. http://www.who.int/en/news-room/fact-sheets/detail/dioxins-and-their-effects-on-human-health.

Yang, Y. (2016). China made 85 billion sanitary pads last year, and not one tampon. Here's why. LATimes.

Menstrual hygiene products, such as tampons and pads, cost US consumers some $3.1 billion per year (Euromonitor, 2017). At the same time, 49.8 billion tampons and sanitary pads plus their packaging end up in landfills or sewer systems each year in the US, meaning that the economic and environmental cost of these products is high. Can the menstrual cup help solve both of these problems? Can a change in menstrual hygiene sanitation help achieve the United Nations’ Sustainable Development goals #5 "gender equality" and #6 "clean water and sanitation" by the year 2030? Can we promote two social goods: both gender equality and environmental sustainability?

Menstrual cups are made of medical-grade silicone or natural latex and inserted into the vagina to collect (not absorb) menstrual fluid. They can be left in place for up to 12 hours. The advantage over tampons and pads is that they are reusable and last for 4 to possibly 10 years.

The purpose of this case study is to encourage manufacturers to provide products that are safe and effective—from the point of view of environmental impact, cost, and health.

Gendered Innovations:

  • Menstrual cups are good for the environment because they reduce waste.
  • Menstrual cups are good for gender equity because they reduce cost.
  • Menstrual cups are good for women’s health.

 

 

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