Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries—A Review of the Literature

Abstract

Menstrual hygiene management (MHM) has gained some attention and several literature reviews have been published. However, both original papers and reviews tend to focus on absorbent access and use and not on the disposal of menstrual waste. This review aims to fill a gap in the water, sanitation and hygiene (WASH) sector by bringing a focus specifically on menstrual hygiene safe disposal in low- and middle-income countries (LMIC). We reviewed published literature since 2002 on menstrual hygiene with a focus on menstrual waste management and menstrual absorbent disposal in LMIC. Database searches were conducted of both peer reviewed literature and grey literature, in addition to hand searching of references of relevant earlier literature reviews. In total 152 articles and reports were identified and 75 met the inclusion criteria and was included in the final review. Existing polices on MHM was also reviewed with a focus on India and South Africa. The review showed that disposal of menstrual waste is often neglected MHM and sanitation value chains, leading to improper disposal and negative impacts on users, the sanitation systems and the environment. Findings call for further research to gain better understandings of MHM waste streams, disposal behaviors, absorbent materials and waste management technologies to deliver health, safety, mobility and dignity for women and girls.

Assessing the effectiveness of a comprehensive menstrual health intervention program in Ugandan schools (MENISCUS): process evaluation of a pilot intervention study

“…Poor MHH can result from inadequate education and knowledge of puberty and menstruation and from inadequate access to high-quality menstrual materials, clean water, disposal facilities and privacy for safe and effective personal hygiene [1,3,4]. Effective MHH interventions may lead to sustained benefits for education [5], health, productivity [1,6] and the environment [7]. There is however, a lack of evidence of interventions to improve MHH in schools and to improve school attendance [2,8].…”

Inserting informed choice into global menstrual product use and provision

“…With many brands of cups lasting up to 10 years, the product is a cost-effective option and could reduce distribution challenges inherent in providing monthly supplies of disposable products and waste management issues from single-use products. 9 However, the pooled estimate of 27% of users who might not find cups acceptable would not be aided by their provision and might feel pressured to continue use despite insertion difficulties and pain.…”

A Gender Lens into Sanitation Technology Innovation

“…In contrast, some teams focused exclusively on menstrual hygiene management without considering anything else through a gender lens. Across the sanitation sector, the focus on menstrual hygiene management tends to focus on disposable absorbent access and washing facilities for reusable absorbents, with far less attention paid to menstrual absorbent waste management (Elledge et al 2018). Broader issues around gendersensitive practices and preferences for women and girls, such as female urination, safety, privacy, lighting, and space, were often addressed, but not consistently across teams.…”