May 28, 2015 | ,

Managing menstruation in low-resource settings: are cups the key?

If we’re serious about equity and girls’ and women’s empowerment, we need to stop giggling and provide more options for them.
School girls gather in a group.
Managing a period is challenging in low-resource settings where girls may have a 10-hour (or more) school day. Photo: PATH/Wendy Stone.

Hope Randall, communications associate at PATH, recently interviewed Nancy Muller, senior program officer for our Devices and Tools Program, to learn more about PATH’s work in menstrual hygiene and solutions that can make an impact in low-resource settings. Following are excerpts from their interview.

How did you first become involved with the issue of menstrual hygiene?

In 2006, I was en route to Seattle from Uganda. I was traveling with our very own Sara Tifft, director of the Sayana Press Pilot Introduction and Research project at PATH, who asked me what I thought low-income girls in Africa did when they had their periods. I felt like the bottom of the plane had dropped out! I had never thought about it. I became a bit obsessed with understanding how girls and women manage their periods, especially if they live in rural areas. My first passion was medical waste management, which was great preparation for my work in menstrual hygiene management.

A group of brightly colored menstrual cups arranged in a circle.
Menstrual cups, which are worn inside the vagina during menstruation to catch fluid, come in a wide variety of styles, capacities, and firmness levels. Photo. Wikimedia/MeLuna.

We are currently conducting a review and landscape of menstrual cups to identify design and user challenges; develop design concepts to address barriers around cost, use, and cleaning; and contribute to the dialogue on improved menstrual hygiene (MH) products by publishing our work.

Why menstrual cups, as opposed to pads or tampons or reusable cloths?

We think there is a need for many improved product choices. Menstrual cups sidestep many challenges associated with other menstrual hygiene products in low resource settings. For example, pads, which have to be purchased every month, may not be either available or affordable. And in poor areas, where women may not have underwear, it is tricky to keep a disposable or reusable cloth pad in place.

Menstrual cups hold up to 12 hours of menstrual fluid and also help eliminate waste by lasting up to 10 years. Disposal bins are not available in the majority of bathrooms or latrines in low resource areas, and discarded MH products may end up clogging toilet pipes, filling pit latrines, or collecting along roadsides and in rivers. They become added environmental hazards where children live and play and eat and drink.

Importantly, menstrual cups are discreet, can prevent leaking, and eliminate odor—features that are important to women.

Girl looks back at camera among a large group of girls facing the other way in a classroom.
Ugandan schoolgirls. Photo: PATH/Will Boase.

Have you encountered any resistance from women about using menstrual cups?

I have to say that I was not a proponent of menstrual cups originally. I didn’t think there would be a high level of acceptability in traditional, rural areas, but a study done among low-income women in rural Bihar, India, completely opened my mind. Half of the 480 women who had been using rags and who were then given a cup, used it; many kept using it beyond the study. That’s pretty telling! It speaks volumes to the headaches that women go through just to manage their periods. Considering what women are doing currently, it’s easy to see why a menstrual cup would be appealing.

The bottom line is that the shame around menstruation just has to go. There wouldn’t be life without menstruation! So why should a period hold girls and women back? If we’re serious about equity and girls’ and women’s empowerment, we need to be serious about their right to manage menstruation safely, effectively, affordably, and with dignity.

You may read this article in its entirety on the DefeatDD blog.

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  • Hope Randall is a digital communications officer in the Vaccine Development Program at PATH.
  • Nancy Muller is a senior program officer with the Devices and Tools Program at PATH.