Exploring menstrual products: A systematic review and meta-analysis of reusable menstrual pads for public health internationally

Abstract

Background Girls and women need effective, safe, and affordable menstrual products. Single-use menstrual pads and tampons are regularly provided by agencies among resource-poor populations. Reusable menstrual pads (RMPs: fabric layers sewn together by an enterprise for manufacture of menstrual products) may be an effective alternative. Methods For this review (PROSPERO CRD42020179545) we searched databases (inception to November 1, 2020) for quantitative and qualitative studies that reported on leakage, acceptability, or safety of RMPs. Findings were summarised or combined using forest plots (random-effects meta-analysis). Potential costs and environmental savings associated with RMPs were estimated. Results A total of 44 studies were eligible (~14,800 participants). Most were conducted in low- and middle-income countries (LMIC, 78%), and 20% in refugee settings. The overall quality of studies was low. RMP uptake in cohort studies ranged from 22–100% (12 studies). One Ugandan trial among schoolgirls found leakage with RMPs was lower (44.4%, n = 72) compared to cloths (78%, n = 111, p<0.001). Self-reported skin-irritation was 23.8% after 3 months among RMP-users in a Ugandan cohort in a refugee setting (n = 267), compared to 72.8% at baseline with disposable pad use. There were no objective reports on infection. Challenges with washing and changing RMP were reported in LMIC studies, due to lack of water, privacy, soap, buckets, and sanitation/drying facilities. Among 69 brands, the average price for an RMP was $8.95 (standard deviation [sd] $5.08; LMIC $2.06, n = 10, high-income countries [HIC] $10.11), with a mean estimated lifetime of 4.3 years (sd 2.3; LMIC 2.9, n = 11; HIC 4.9 years, n = 23). In 5-year cost-estimates, in LMICs, 4–25 RMPs per period would be cheaper (170–417 US$) than 9–25 single-use pads, with waste-savings of ~600–1600 single-use pads. In HICs, 4–25 RMPs would be cheaper (33–245 US$) compared to 20 single-use tampons per period, with waste-savings of ~1300 tampons. Conclusion RMPs are used internationally and are an effective, safe, cheaper, and environmentally friendly option for menstrual product provision by programmes. Good quality studies in this field are needed.

Use and perceptions on reusable and non-reusable menstrual products in Spain: A mixed-methods study

“…Particularly those between 26 and 35 were the ones reporting the highest use of reusable products. An explanation for these differences may be the differential access to menstrual learnings and opportunities to access a variety of menstrual products across generations [ 7 , 22 , 23 ]. Besides, the fact that participants from the youngest age group reported less use of reusable products than older participants may be related to agency and time for self-learnings.…”

“…Furthermore, menstrual inequity needs to be discussed when referring to the use and perceptions of menstrual products. Informed choice on menstrual products has been argued to be limited, partly due to commercial interests and the unbalanced information available on different menstrual products [ 7 , 22 , 30 ]. As Tarzibachi argues [ 31 ], menstrual taboo and stigma were reinforced by publicists as menstrual products were marketed as required for “feminine protection” and related to “hygiene” in the 1920s-1950s.…”

“…Interestingly, nearly all research has focused on investigating the use and acceptability of reusable products (e.g., menstrual cup, reusable pads or menstrual underwear) rather than non-reusable products. The reusable products are increasingly gaining attention as new tools for menstrual management [ 7 ]. Available evidence suggests that the menstrual cup is generally acceptable [ 7 – 10 ] and may positively contribute to reducing menstrual-related school absenteeism [ 11 ] and thus play a part in attaining menstrual equity.…”

“…The reusable products are increasingly gaining attention as new tools for menstrual management [ 7 ]. Available evidence suggests that the menstrual cup is generally acceptable [ 7 – 10 ] and may positively contribute to reducing menstrual-related school absenteeism [ 11 ] and thus play a part in attaining menstrual equity. Menstrual cups are also perceived to be more environmentally friendly and have less economic impact [ 11 ], although reusable products are not affordable [ 12 ] or acceptable to all women and people who menstruate (PWM).…”

“…While most research on use and acceptability of reusable products has been conducted in African and Asian countries, studies in the Global North are mostly limited to the United States [ 7 ]. Also, research on use and acceptability of products should consider how women and PWM access and use them based on different social axes such as age or place of birth.…”