|Year : 2023 | Volume
| Issue : 3 | Page : 357-363
Nonconventional menstrual hygiene products and its usage among reproductive age group women in India – A cross-sectional study
Dharmaraj Rock Britto, Neethu George, Abdul Malik Shagirunisha Rizvana, Josephin Shalini Ratchagar, Tamilarasan Muniyapillai, Karthikeyan Kulothungan
Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
|Date of Submission||30-Aug-2022|
|Date of Acceptance||19-Jan-2023|
|Date of Web Publication||29-Aug-2023|
Dr. Neethu George
Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur - 621 113, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Menstrual hygiene is influenced by various factors including the products used by women during the cycle. The up-to-date and recent products like menstrual cups and tampons make women more comfortable during the day. The study aimed to assess the perception of usage and awareness of women in the reproductive age group regarding nonconventional menstrual hygiene products such as tampons and cups. Methodology: This was a cross-sectional study done among 525 subjects belonging to reproductive age group. The data was collected through questionnaires circulated in the form of Google forms. The questionnaire contained general socio-demographic details, menstrual history details, and the details regarding the usage of sanitary pads its difficulties and the use of menstrual cups or tampons and its advantages. The data were analyzed using various appropriate statistical tests. Results: Among the study subjects, 445 (84.8%) are aware that menstrual cups or tampons are present as an alternative to sanitary pads. In this study, 489 (93.1%) have never tried tampons or menstrual cups during menstrual cycles. The most common reason for not trying menstrual cups or tampons among these subjects is as follows: afraid to insert foreign body 190 (38.9%). The study showed that 489 (93.15%), 13 (2.5%), and 23 (4.4%) subjects were currently using sanitary pads, tampons, and menstrual cups respectively. Conclusion: The study showed that the use of nonconventional sanitary products like menstrual cups or tampons was less among the study group even with high awareness. The need of right path about the appropriate and fitting menstrual hygiene product for the generation is portrayed.
Keywords: Awareness, menstrual cup, menstrual hygiene, tampons
|How to cite this article:|
Britto DR, George N, Shagirunisha Rizvana AM, Ratchagar JS, Muniyapillai T, Kulothungan K. Nonconventional menstrual hygiene products and its usage among reproductive age group women in India – A cross-sectional study. J Datta Meghe Inst Med Sci Univ 2023;18:357-63
|How to cite this URL:|
Britto DR, George N, Shagirunisha Rizvana AM, Ratchagar JS, Muniyapillai T, Kulothungan K. Nonconventional menstrual hygiene products and its usage among reproductive age group women in India – A cross-sectional study. J Datta Meghe Inst Med Sci Univ [serial online] 2023 [cited 2023 Nov 29];18:357-63. Available from: https://journals.lww.com/dmms/pages/default.aspx/text.asp?2023/18/3/357/384742
| Introduction|| |
”The survival of human species lies in its reproduction and the functioning depends in the menstruation-so there should be options and facilities which make the women to experience and celebrate the Womanliness flaunty.”
Menstrual hygiene is vital to the empowerment and well-being of women and girls. The creation of a comfortable environment is necessary which values and supports a women's ability to manage their menstruation with dignity. Poor menstrual hygiene can affect health and well-being of reproductive females and unhygienic practices lead to reproductive tract infections. Menstrual hygiene management (MHM) is defined as “Women and adolescent girls utilizing a clean menstrual management material to absorb or collect blood that can be altered in privacy as often as necessary for the duration of the menstruation period, using soap and water for washing the body as essential and having access to facilities to dispose of used menstrual management materials. Also includes how to manage it with dignity and without discomfort or fear.”, The effective MHM needs social support, facilities, knowledge, skills, and materials.
A wide variety of menstrual hygiene materials, under many diverse product names, are accessible around the world. Many products are marketed by their manufacturers with claims of appropriateness, culturally acceptability, cost-effectiveness, or decreased environmental effect and few of these claims are supported with credible data on usability and cultural acceptance of users. Depending on personal preferences, available resources, economic status, traditions, cultures, education and knowledge, women and girls use various menstrual products. There are also cultural and social issues in the adoption of nonconventional menstrual hygiene products, especially in country like India. Menstruation and associated activities are enveloped by silence, shame, and social taboos that are further exhibited in social practices that restrict mobility, freedom, and access to normal activities.,
As time evolves changes in the use of conventional products such as cloths, sanitary pads have taken place which gives way to newer products such as reusable pads, tampons, and menstrual cups. The conventional menstrual product like sanitary pads, which is commonly used have problems of leakage, unpleasant odor, discomfort, irritation, and rashes. It has been estimated that an average female uses 10,000 menstrual hygiene products in their lifetime. Tampons are cylindrical inserts, placed inside vagina. They are compact, hence more comfortable, no visibility, no leakage, no odor, and allow swimming. However, there should be adequate knowledge about its usage, time of disposal. Tampon is believed to be restricted only to adult and married women.
Menstrual cups are bell-shaped cups made of silicone or rubber. These menstrual cups are reusable, economical, eco-friendly, no leakage, and no odor. It also has the added advantage of monitoring amount of blood loss and prevent disposal of several million pads. This product hopefully can bridge the gap in menstrual hygiene products and also the health of reproductive women., Considering all the benefits of nonconventional products over conventional products, women and girls should be given chance to opt the better and lasting solutions. [Table 1] gives the features of various menstrual hygiene materials.
The National Family Health Survey 2015–2016 estimates that of the 336 million menstruating women in India, about 121 million (roughly 36%) women are utilizing sanitary napkins, locally or commercially produced. Based on various studies, the usage of disposable pads during menstruation was 40%–90%.,,,, Many studies in foreign countries showed the use of menstrual cups and tampons from the initial 1990s.,, The Indian women found it difficult to accept and there are not many studies done regarding the perception of Indian women about the nonconventional menstrual hygiene products like tampons and cups.
The study aimed to assess the perception of usage and awareness of women in the reproductive age group regarding nonconventional menstrual hygiene products like tampons and cups. The study also assesses the utilization of various products and its difficulties.
| Methodology|| |
We conducted a cross-sectional study using web-based platforms among reproductive age group women within 2 months (July 2021–August 2021). The data were collected from among the reproductive age group women who could be contacted via social media platforms and E-mail facilities. Furthermore, snowball sampling was done to acquire as many samples as possible. Ethics committee approval was taken from the institution ethics committee and informed consent was taken before the start of the study. This clinical research was done following the ethical principles for medical research involving human subjects in accordance with the Helsinki Declaration 2013.
The sample size was calculated using the anticipated 50% awareness toward nonconventional menstrual hygiene products and after applying the formula, n = zα2pq/d2 (zα = 1.96, p = 50, q = 50, d = 5), the sample size came up to 384. The study collected data from 525 subjects. The questionnaire was pretested on 15 late adolescent females who were later excluded from the study and analysis. The internal consistency of the study questionnaire was evaluated by calculating the Chronbach's alpha which came to 0.65 which shows it is reliable and acceptable.
The objective was assessed using a questionnaire made up through the G suite application and disseminated through social media platforms. The questionnaire contains sections-personal details – Age, education, occupation, religion, place and state of residence, and menstrual history – menarche age, duration, regularity, use and access of menstrual hygiene products. The next section had questions related to sanitary pads (usage, disposal, and discomfort if any) and nonconventional menstrual hygiene products such as tampons and menstrual cups-usage, source of information, reasons for its choice and discomfort arise from it. The questions on discomfort were asked in a Likert scale-agree, neutral, and disagree.
The data collected was entered into Microsoft Excel and analyzed using SPSS version 23[IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp]. The descriptive analysis was analyzed using frequencies, mean, standard deviation (SD) and proportions. The association among subjects with the use of conventional and nonconventional menstrual hygiene products was done with the help of independent t-test and Chi-square test accordingly.
| Results|| |
The study was done among 525 subjects with a mean (SD) age of 26.46 (7.70) years ranging from 15 to 49 years. Among the subjects, majority 361 (68.8%) belonged to the Hindu religion and 122 (23.2%) were Christians. Most of the study subjects reported the highest education qualification as plus two 212 (40.4%) followed by graduate 159 (30.3%) and 144 (27.4%) postgraduates. Most of the subjects were doctors in various streams 149 (28.4%) followed by medical course students 140 (26.7%), salaried professionals 94 (17.9%), college students 77 (14.7%) and homemaker 37 (7%). Among the subjects, 77.1% were residing in urban area like town Panchayat or city. Majority of the study subjects 341 (65%) resides in the state of Tamil Nadu, followed by 157 (29.9%) Kerala and the rest from other states such as Karnataka, Pondicherry, Andhra Pradesh, and Delhi.
The mean (SD) age of onset of menarche among the subjects was 12.90 (1.39) years with minimum age of 9 and maximum of 18 years. In most of the subjects, 426 (81.1%) had regular menstrual cycles (21 days to 35 days). Most of the subjects 404 (77%) had cycle duration of 3–5 days. Among the subjects, 399 (76%) described their periods flow to be average and 91 (17.3%) described it as heavy. [Table 2] shows the menstrual hygiene products the subjects have used at any point of time.
In the study, subjects were currently using these products in a preferential order-disposable sanitary pads, piece of clean cloths, menstrual cups, reusable pads, tampons, and clothes of any kind. In the study, 293 (55.8%) subjects access the menstrual hygiene products from supermarket, 154 (29.3%) from medical shop, 41 (7.8%) from online shopping, 35 (6.7%) from stationary shop, and 2 (0.4%) government school free pads.
Sanitary pads use history (n = 517)
The study showed that 517 (98.48%) used sanitary pads alone or along with cloths, menstrual cups, and tampons. In most of the subjects, 341 (65.96%) changed 3–4 pads during the heavy flow day. Most of the subjects dispose of sanitary pads by disposing at waste bins 323 (62.48%), then by burning 178 (34.43%), flushing in toilet 14 (2.71%), and disposing in open fields 2 (0.4%). [Figure 1] shows the various discomforts faced while using the sanitary pads.
Among the study subjects who are using sanitary pads, 337 (65.2%) were not able to participate in physical activities such as running, skipping, or swimming during the time of menstrual cycles.
Among the study subjects, 445 (84.8%) are aware that menstrual cups or tampons are present as an alternative to sanitary pads. Among those who are aware 326 (73.3%) came to know about it from social media, 84 (18.9%) from friends/colleagues, 17 (3.8%) from family members, 15 (3.4%) from health-care providers, and 3 (0.7%) from education settings
In this study, 489 (93.1%) have never tried tampons or menstrual cups during menstrual cycles. The reasons for not trying menstrual cups or tampons among these subjects are as follows: Afraid to insert foreign body 190 (38.9%), satisfied with the usage of pads or cloths – 181 (37%), improper awareness – 53 (10.8%), afraid of infections – 44 (9%), and cleaning issues – 21 (4.3%).
Tampon usage history
Among the study subjects only 13 (2.5%) have been using tampons as a menstrual hygiene product. The mean (SD) age of tampon-use respondents was 35.46 (9.76) years with 84.5% with highest education qualification of graduate or above. Most of the respondents 76.9% were salaried and 84.6% lived in urban area.
Among these subjects, 8 (61.53%) were using it along with pads. The awareness about it came from – 6 (46.2%) from social media, 4 (30.8%) from friends, 2 (15.4%) from family and 1 (7.7%) from health-care practitioner. Most of the subjects 7 (53.8%) were using it for less than a year, 4 (30.8%) for more than 5 years and 2 (15.4%) for 3–5 years. The insertion and removal of the tampons were practiced using - 6 (46.2%) from social media videos, and others from friends, family, and package instructions. Among these subjects, 7 (53.8%) had difficulty in placement and removal. Furthermore, 3 (23.1%) felt uncomfortable with tampons inside and most of the subjects 4 (30.8%) were using tampons for all days of the menstrual cycle. In this study, 9 (69.2%) were changing <3 tampons per day and 9 (69.2%) actively participate in physical activities during cycles with tampons. Most subjects 11 (84.6%) agreed with the comfort of tampons in case of lesser frequency to change, less/no leakage, eco-friendliness, and ease to use. [Figure 2] shows the discomfort faced during the use of tampons
The figure above showed most of the subjects 9 (69.2%) agreed in terms of foreign body sensation as a discomfort. Furthermore, all the subjects using tampons were aware of the complication like infection when it is used for more than required hours.
Menstrual cup usage history
Among the subjects, 23 (4.4%) were using menstrual cups at the time of their cycles. The mean (SD) age of menstrual cup use respondents was 29.48 (6.37) years with 78.26% with highest education qualification of graduate or above. Most of the respondents 82.6% were salaried and 91.3% lived in the urban area.
Among these subjects, 20 (86.95%) were using it along with pads. Most of the subjects 21 (91.3%) were using it for less than a year. Among these subjects, 13 (56.5%) had difficulty in placement and removal. Furthermore, 20 (87%) emptied their menstrual cups 2–3 times per day and 6 (26.1%) actively participate in physical activities during cycles with cups. Most subjects 21 (91.2%) agreed with the comfort of cups in case of lesser frequency to change, less/no leakage, economically cheaper, ecofriendly, single-time purchase, no disposal, and awareness about the bleeding. [Figure 3] shows the discomfort faced during the use of cups.
The discomfort while using menstrual cups showed by most of the subjects as the difficulty in insertion and removal 18 (78.26%) next as emptying and cleaning issue and foreign body sensation 12 (52.17%).
Association of various variables
The association showed on those older women and women with average and heavy periods were using more of nonconventional products during menstrual cycle. Among women using nonconventional products 17 (47.2%) were Hindus and 15 (41.7%) were Christians. Most of the women 47.3% using the products were postgraduates and 44.4% were salaried [Table 3].
|Table 3: Association of conventional and nonconventional menstrual hygiene products with various variables|
Click here to view
| Discussion|| |
The study aimed at assessing perceptions and awareness about various menstrual hygiene products. Among the study subjects, 445 (84.8%) are aware that menstrual cups or tampons are present as an alternative to sanitary pads. In this study, 489 (93.1%) have never tried tampons or menstrual cups during menstrual cycles. This study result is like a study done in Mangalore India where about 82% were aware about the menstrual cup. In a study done among female college students about menstrual hygiene products, 99.5% were aware of sanitary napkins, 42.7% of menstrual cup, 3.1% of tampon, and 65.8% of reusable cloth.
The study showed that 489 (93.15%), 13 (2.5%), and 23 (4.4%) were currently using sanitary pads, tampons, and menstrual cups, respectively. In a study about awareness about menstrual cup 2.6% was using cups during the time of menstrual cycles. In a study done in Puducherry, 78.1% used only sanitary pads as absorbents. In a study done in Salem, 51.8% used cloth during menstruation and a study done in Gujarat showed, 80 (53.33%) women were using cloths. Chauhan et al. showed that 97% are using sanitary pads. In a study done to assess perceptions regarding tampon use among mothers and their daughters, the majority of them (68% and 56%) uses tampons with more favorable attitude. In a meta-analysis to assess the adaptability and acceptability of menstrual cup, 73% of adults as a pooled aggregate from 13 studies showed a willingness to continue the use of the menstrual cup. In a study done in Karnataka, 1.7% were using tampons as absorbent. In a study done in France Disposable sanitary pads were preferred by 81% of subjects In this study, menstrual tampons were used by 45.6%, washable sanitary pads 4.4%, menstrual panties 1.7%, and menstrual cups 9.4% of the patients. This done in Korea most of the subjects used disposable menstrual pads (89.0%), followed by cloth menstrual pads (4.5%), tampons (4.2%), and 1.6% used menstrual cup.
In the study respondents who used or using tampons agreed in terms of comfort of tampons-lesser frequency to change, less/no leakage, eco-friendliness, and ease to use. Most subjects 21 (91.2%) agreed with the comfort of cups in case of lesser frequency to change, less/no leakage, economically cheaper, ecofriendly, single-time purchase, no disposal, and awareness about the bleeding. Similar responses were seen with tampons about it comfortableness and ease to use among adolescents. Similarly, in a study done to assess the adaptability and effectiveness of menstrual cup by new users, cup was preferred for comfort, dryness, and less odor. The study identified the easiness of insertion and removal for the cup with few side effects such as rashes and irritations. Similar results were also seen in other studies about the absence of leakage and engagement in parallel activities with the cups.,
In the study, most of the subjects 9 (69.2%) agreed in terms of foreign body sensation as a discomfort in case of tampons. The discomfort while using menstrual cups showed by most of the subjects is the difficulty in insertion and removal 18 (78.26%) next to emptying and cleaning issue and foreign body sensation 12 (52.17%). These concerns were not there in a study where insertion and removal were found to be easy in case of menstrual cup. These differences in opinion may be due to the reduced period flow during the use by the respondents which caused dryness and difficulty in usage. Another study showed that tampon loss was a major phenomenon among adolescents in comparison to adult.
The study showed the use of nonconventional menstrual hygiene products more by older age group (31.64 [8.17] vs. 26.07 [7.54] years) and subjects with a higher grade of education and having own money in terms of salary. A study done in Spain showed that younger age group and subjects with higher education used more of reusable menstrual hygiene products like cups and panty liners. The differences may be due to opportunities and learning disparities about these products across various age groups.
The study showed that the use of nonconventional menstrual hygiene products was less in the study population even though the subjects have high awareness. The awareness regarding it is not converted to usage because of misconception or improper directions. Many research have proven and confirmed the comfort of using cups and tampons, including the cost benefit and environmental friendliness of cups. The topic of menstrual hygiene should be taught with not only “when and where” but “what to use.” The adolescents should be given choices like the cafeteria approach with the explanation of possible difficulties and advantages. The presence of leakage which normally a woman dreads during the menstrual cycle can be totally cleared with the use of tampons and menstrual cups. The increased use of these products makes the hygiene matter clearer and acceptable with a financially affordable manner. The advertisement taboo needs to be removed where only conventional products are portrayed rather than the upgraded products. Menstrual hygiene policies should thus not only concentrate on hygiene but also on products which are comfortable ecofriendly and pocket friendly.
The study is limited in the following aspects-collection of data through Google forms which have maintained anonymity but not authenticity, the subjective view regarding the nonconventional products, the data collection among those who have access to Internet, and the social desirability bias among respondents in answering to the questions.
The implications of the study include further studies to assess the barriers in the use of nonconventional menstrual hygiene products like tampons or cups. The perspectives of stakeholders such as parents, health-care providers, and product providers should be collected. The menstrual health and hygiene should be made physiological more than its pathological identity. The benefits and ease to make the women thus the community more comfortable during the inevitable days should be advocated.
| Conclusion|| |
The study concludes that the usage of menstrual cups and tampons was less among the study population even though the awareness regarding it is high. The study ascertained about various advantages and disadvantages of these products. The fear of insertion of a foreign body was the topmost factor preventing the subjects who were aware from using the products. The study subjects agreed in terms of comfort of tampons-lesser frequency to change, less/no leakage, eco-friendliness, and ease to use. Most subjects agreed with the comfort of cups in case of lesser frequency to change, less/no leakage, economically cheaper, ecofriendly, single-time purchase, no disposal, and awareness about the bleeding. The need to address the inequity in getting correct awareness about various menstrual hygiene products and thus promoting satisfying menstrual health needs to be promoted.
We would like to thank all the participants in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]