Final Report

FINAL REPORT
Market Feasibility for Biodegradable

Sanitary Napkins in Pakistan
___________________________________________________________________
October 17, 2022
Prepared by Prepared for

CHIP Training & Consulting Ltd. (UK) GIZ Pakistan
Contents
Acronyms............................................................................................................................................................... 1
Executive Summary .............................................................................................................................................. 3
1. Introduction .................................................................................................................................................. 5
1.1. Objectives of the Assessment ................................................................................................................ 5
1.2. Research Design & Methodology ......................................................................................................... 5
1.3. Finalization of Market Feasibility Assessment Tools ........................................................................... 6
1.4. Quality Assurance and Data Analysis ................................................................................................... 7
1.5. Teams .................................................................................................................................................... 7
1.6. Study Challenges................................................................................................................................... 7
2. Literature Review ......................................................................................................................................... 8
2.1. Importance of Menstrual Hygiene ......................................................................................................... 8
2.2. Global Perspective ................................................................................................................................ 8
2.3. Pakistan‘s Layout Regarding MHM.................................................................................................... 11
2.4. Available Studies from Pakistan ......................................................................................................... 12
2.5. Initiatives to include MHM in Educational Curriculum ...................................................................... 14
2.6. Coordination Platforms/ Mechanisms ................................................................................................. 15
2.7. Use of Social Media ............................................................................................................................ 15
3. Demographics.............................................................................................................................................. 16
3.1. Number of Respondents ...................................................................................................................... 16
3.2. Types of Respondents ......................................................................................................................... 17
3.3. Male Household Head/Guardian Education ........................................................................................ 17
3.4. Parents/Guardian Occupation .............................................................................................................. 18
4. Menstrual Knowledge ................................................................................................................................ 18
4.1. Pre Menstrual Knowledge ................................................................................................................... 18
4.2. Source(s) of Information ..................................................................................................................... 20
4.3. First Information Source on Periods ................................................................................................... 20
4.4. Menstruation Age ................................................................................................................................ 21
4.5. Number of Menstruation days ............................................................................................................. 21
5. Menstrual Management Preferred Material .................................................................................................. 22
5.1. Sanitary Pads Source of Information................................................................................................... 23
5.2. Preparations before Periods................................................................................................................. 23
5.3. Preferred Brand(s) ............................................................................................................................... 24
5.4. Reason(s) for Preference of Used Material ......................................................................................... 25
5.5. Pads Availability ................................................................................................................................. 25
5.6. Purchasing Source ............................................................................................................................... 26
6. Health........................................................................................................................................................... 26
6.1. Food Preferences ................................................................................................................................. 26
6.2. Types of Health Issues, Symptoms and Fears ..................................................................................... 27
7. Costing ......................................................................................................................................................... 28
7.1. Pads Used Per Cycle .................................................................................................................................. 28
7.2. Frequency of Changing Pads ..................................................................................................................... 28
7.3. Monthly Cost ............................................................................................................................................. 29
8. Waste Management Practices .................................................................................................................... 30
8.1. Disposal of Pads ........................................................................................................................................ 30
8.2. Households Waste Disposal....................................................................................................................... 31
8.3. Pads Material ............................................................................................................................................. 31
8.4. Knowledge on Biodegradable Pads ........................................................................................................... 32
8.5. Willingness to buy Biodegradable Pads .................................................................................................... 32
9. Beliefs around Menstruation ..................................................................................................................... 32
9.1. Restriction to Burn ..................................................................................................................................... 32
9.2. Carrying Heavy Weight leads to Reproductive Health Issues ................................................................... 33
9.3. Spicy Foods Restrictions ........................................................................................................................... 33
9.4. Open Discussion Prohibited....................................................................................................................... 34
Market Feasibility for Biodegradable Sanitary Napkins in Pakistan i

9.5. Restrictions on Performing Routine Activities .......................................................................................... 34
9.6. Menstruation Impurity ............................................................................................................................... 35
9.7. Bathing Prohibition .................................................................................................................................... 35
10. Shopkeepers ................................................................................................................................................ 36
10.1. Availability of Pads ................................................................................................................................. 36
10.2. Cost of Pads ............................................................................................................................................. 37
10.3. Consumers Preferences/ Choices ............................................................................................................. 38
10.4. Types of Consumer .................................................................................................................................. 38
10.5. Sanitary Management Awareness/ Promotions ....................................................................................... 39
10.6. Health and Environmental Concerns ....................................................................................................... 40
11. Household Heads ........................................................................................................................................ 43
11.1. Shopping Trend(s) ................................................................................................................................... 43
11.2. Knowledge on Menstrual Products Used at Home .................................................................................. 44
11.3. Monthly Spending on Pads ...................................................................................................................... 45
11.4. Willingness of Males for Buying Pads .................................................................................................... 45
11.5. Disposal Practice ..................................................................................................................................... 46
11.6 Knowledge on Production Materials of Pads ............................................................................................ 47
11.7 Willingness to Buy Environmental-friendly Pads .................................................................................... 47
12. Manufacturers ............................................................................................................................................ 48
13. Recommendations ....................................................................................................................................... 48
Annexures ............................................................................................................................................................ 50
Annex I: Data Collection Tools ........................................................................................................................ 50
Annex II: Lists of Cities and Institutions Consulted for Data Collection ......................................................... 58
Annex III: Analysis Tables ............................................................................................................................... 61
Annex IV: Ethical Protocols and Consent Form(s) .......................................................................................... 71
Market Feasibility for Biodegradable Sanitary Napkins in Pakistan ii

Acronyms
AGAHE Association for Gender Awareness & Human Empowerment

BCC Behavioural Change Communication
DTC DevTrio Consultants
EPR Employment Processing Resource
FGD Focus Group Discussions
GIZ Gesellschaft für Internationale Zusammenarbeit
Govt Government
GPL Geolinks Private Limited
HANDS Health and Nutrition Development Support
IEC Information and Education Materials
IRSP Integrated Regional Support Programme
IRSP Integrated Regional Support Program
ISB Islamabad
KII Key Informant Interviews
KPK Khyber Pakhtunkhwa
LAL Learning, Acting, and Learning
LHWs Lady Health Workers
MH Menstrual Hygiene
MHM Menstrual Hygiene Management
MPA Member of the Provincial Assembly
NGOs Non-Governmental Organizations
NRSP National Rural Support Programme
O&M Operation and Maintenance
PATS Pakistan Approach to Total Sanitation
PATS+ Particle and Temperature Sensor
PVCs Polyvinyl Chloride
RSPN Rural Support Programmes Network
Schl School
SDGs Sustainable Development Goals
SPO Strengthening Participatory Organization
TORS Terms of Reference
Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 1

UNICEF United Nations International Children's Emergency Fund
USAID United States Agency for International Development
WAP Water Aid Pakistan
WASH Water, Sanitation and Hygiene
WG Working Group
WinS Wash in Schools
WSSCC Water Supply and Sanitation Collaborative Council

Executive Summary
The Market Feasibility Study for Biodegradable Sanitary Napkins in Pakistan is a part of GIZ Global
Project Sanitation for Million (S4M) that is working along the four lines fostering access to adequate
and equitable sanitation and hygiene in public institution, improving sanitation and hygiene at
household level, capacity strengthening of sanitation service providers and monitoring and evaluation
by ensuring the financial sustainability for sustainable transformational change. For this study, survey
and focus group discussions were conducted with women to capture their responses around three
factors including (i) socio-cultural, (ii) economic and (iii) environmental by dividing them into six
major categories including menstrual knowledge, preferred menstrual management material and its
costs, health, waste disposal practices and beliefs around menstruation. Moreover, key informant
interviews with service providers (shopkeepers, manufacturers) and female community influential and
household heads were also conducted.
The data on menstrual practices was collected from 3089 women including 2751 through survey
questionnaire and 338 in FGDs from 12 cities in four provinces. Among these participants, 939
(30%) were household women, 1643 (53%) students and 507 (16%) working women. Additionally,
182 shopkeepers 17 (9%) women and 165 (91%) men were also interviewed for this assessment. To
gauge the understanding on menstruation and assess the willingness of men to spend on menstrual
materials for women, 135 (male) heads of households were also interviewed. Focal persons from
Syntax and Anion were also taken on board for sharing their point of view regarding the available
products and prospects for biodegradable pads. In communities, the existing initiatives were also
explored including schools for girl-friendly toilets and community sanitary pads production unit(s) in
Muzzafargurh.
Overall, more than 20 sanitary pads brands were reported in all 12 cities. In Balochistan the Iranian
brands were more common whereas in Karachi and Punjab the duplicate copies of some major brands
were also reported (which the respondents referred as ‗Chinese products‘ with less prices as compared
to the original prices). The most favourite brands were Always (48%) and Butterfly (18%) whereas
mixed brands multiple types were also reported by 25% respondents. The study found that 28%
respondents shared that they did not have pre-menstruation knowledge at the time of their
menstruation. This ratio was slightly higher in group discussion where 35% to 40% respondents
shared that they did not have knowledge at the time of their period. The highest information source on
menstruation 72% were family member especially mothers and sometimes elder sisters, aunts or
grandmothers. Moreover, 79% women reported that they got their period between the ages of 11 to 14
while 89% women shared that their periods stay from 5 to 7 days.
Regarding the use of pads, 14% respondents shared that they use cloth (8% reusable and 6% new
cloths). Whereas, 4% use cotton and 11% respondent shared to have mixed material (cloth pads, pads,
cotton and cloth, tissue papers) depending on the locations and situations. Homemade pads were
found common in semi-urban areas especially where the NGOs have provided trainings to the
communities switched from cloth to homemade pads or cotton pads. It was also found in many of the
university students that due to allergy they were more comfortable to use cotton or cloth pads (in
almost every FGD 20% students shared they use cloth/cotton pads due to severe allergy after trying so
many products and doctors‘ consultations). A small number (0.20%) was also using baby pampers
while overall 70% were using pads. The main sources of information declared television (61%) and
LHWs (28%) as the leading outlets whereas friends, schools and NGOs also were found to provide
information on pads. 69% respondent also shared that they kept themselves prepared as majority of
them (the working women and students) have to go outside of their homes.
Comfort and safety (52%) was the reason followed by easy disposal (48%) for selection of the brands.
Leakage free, absorption and infection free were also main reasons of selection. 73% respondents

shared that pads were available in their nearest shops and 13% reported to have no knowledge as they
were not directly engaged in buying of their pads but rather relied on the parents to provide them as
37% shared that mostly their parents purchased the pads and they are not allowed themselves. But
46% respondents shared that they shopped themselves as they stay/ work outside of their homes.
Furthermore, it was reported by 57% respondents that they spend between 100 to 600 PKR on pads
monthly. While sharing their disposal practices, 11% respondents were reported to burn their pads
with another 4% to burry underground. Mostly, the household waste disposal sources were private
trash collectors (50%) with 33% reported as municipal bins. In addition, 52% respondents had no
knowledge about the composition of materials used in pads whereas 23% shared it was made up with
cotton while 22% stated that plastic was used. It was reported by 92% respondents that they had ‗no
knowledge‘ about biodegradable pads. Nonetheless, 65% shared their willingness to buy
biodegradable pads if good quality pads with high absorption were introduced in the market.
On the other hand, the shopkeepers shared that the products‘ availability in shops were based on
consumer preferences. They also reported that most of the customers were female (59%). Almost 95%
shopkeepers did not know about the waste disposal practices in the area and 85% did not know about
the decomposing duration of pads. It was also noted that an overwhelming majority of shopkeepers, at
98%, did not know about biodegradable pads. The shopkeepers share that if biodegradable were
introduced in the market, then it depends on the quality, price and demand by the consumers as these
values are determined by the consumer choice instead of the shopkeeper choice. They lamented that
the sale of new brand is always risky and they would only take the risk once the demand is generated
by the company and the consumers start knowing and demanding the products. Whereas, the 57%
(male) heads of households shared that they spent around 100 to 1000 PKR on pads monthly.
Moreover, 84% believed that pads created environmental pollution and added a lot of waste.
The discussions with manufacturer, including Syntax and Anion, highlighted that due to heavy duties
on imports the biodegradable pads will not be very cost effective as some material(s) may need to be
imported. They also shared concerns that the taxes from the government would further lead to
increase in the prices that might complicate the selling of the product as the quality and absorption of
biodegradable pads may not be up to the standards in comparison to some other brands that are chosen
due to their absorption quality and thinness. The manufacturers further suggested that strategies need
to be worked with the government to reduce the tax so that the product could reach masses easily as
well as a plan to work with the media groups, schools and academic institutions to highlight the
environment-related impacts of using conventional pads to launch a preference for biodegradable
products.

1. Introduction
Access to safe and dignified menstruation is a fundamental right of every woman and girl. Menarche
is a key development transition in girls to womanhood. These practices shape their lives physically
and emotionally which has an impact on the future and influences various aspects of life. Safe
menstrual hygiene management is a Water, Sanitation and Hygiene (WASH) indicator under
Sustainable Development Goal (SDG) 6 (i.e. ‗Clean Water and Sanitation). But achievement of this
indicator is dependent on many factors related to knowledge and awareness about safe menstrual
management, availability and access to safe menstrual products, cultural and religious beliefs
associated with menstruation management, affordability of menstrual products and safe disposal of
menstrual material and public private sector willingness to improve the situation on WASH and
Menstrual Hygiene Management (MHM). The current assessment is part of GIZ Sanitation for
Million (S4M) global project in partnership with Syntax to introduce biodegradable sanitary pads in
Pakistani sanitation market. The project aims at fostering access to adequate and equitable sanitation
and hygiene in public institutions and improving the sanitation and hygiene at household level as well
as capacity development of sanitation service providers.
1.1. Objectives of the Assessment
The objective of assessment is to determine the usage of sanitary pads by conducting survey(s) and
focus group discussions (FGDs) to assess the current menstrual practices of women and girls and their
preferred choices regarding sanitary pads. In this view, the survey and FGDs were designed to gauge
the consumer habits, the preferences in terms of convenience and awareness of women and girls
related to sanitary pads, practices and beliefs regarding MHM. This took into consideration the
demand (women/girls and household heads) and supply side (shopkeepers and manufactures) to assess
the overall situation in four provinces (12 cities). Overall, the data collection was focused on three
major domains: (i) socio-cultural and religious; (ii) environmental; and (iii) (economic) factors.
1.2. Research Design & Methodology
The following steps elaborate the steps that were taken to complete the assessment study:
(Quantitative
Tools testing
& Qualitative
Sharing of and revising Submission
data) data Data, Submission
Inception inception tools based of Final
collection in cleaning, of
meeting with report, on tests & Report after
field, FGDs, coding and
GIZ methodology tools Draft Report Inputs from
KIIs & house Analysis
andd tools translation in GIZ
to house
urdu
survey
1.2.1 Research Method

The data collection pursued a mixed-method approach including survey (house-to-house as well as
online), key informant interviews (KIIs) with head of household, shopkeepers, manufacturers. In
addition to this, the FGDs were conducted with household women, students and working women
along with participatory discussions with school girls and teachers, school visits (to understand the
initiatives on MHM-friendly toilets in Muzzafargurh in particular).
1.2.2 Sampling Technique

In order to conduct an in-depth assessment, twelve cities were selected from four provinces including
six from Punjab, two from Khyber-Pakhtunkhwa (KPK), two from Sindh and two from Balochistan.

In each city, house-to-house visits were conducted and data on mobile phones as well as in hard forms
(where internet facility was not available/disrupted due to flood) were completed. Moreover, data
from schools, colleges and university students were collected by contacting the administration of
institutes or by personals contacts. However, it was noted that the universities were mostly closed due
to summer vacations and floods in Balochistan and Sindh. In order to address this limitation, the focal
class teachers and students in the research labs were engaged with research teams to collect the
maximum number from each city.
It should be elucidated that minority groups and women with disabilities were also included in the
survey and discussions. The KIIs with the focal person of Syntax, Anion, Sangat (community pads
producers), and officials from Water Aid and UNICEF were also conducted. Some KIIs in
communities, with lady health workers (LHWs), influential women supporting MHM activities in
Muzzafargurh were also conducted. In addition to this, discussions with teachers in Muzzafargurh
where projects on MHM had taken place or were being conducted were taken into consideration to
determine the sustainability of the initiative during field visits. Lastly, the shops were selected in all
cities in such a way that it represented the overall sample of the city. Around those shops, household
visits were also conducted. The heads of household were interviewed on shops (during shopping) as
well as in the communities to assess their willingness to pay for sanitary napkins.
1.3. Finalization of Market Feasibility Assessment Tools
After submission of Inception Report and discussions with GIZ, the testing of qualitative and
quantitative tools was finalized. The tools were then translated in Urdu language (i.e. local language)
to orient the field teams for data collection in the field.
1.3.1 Knowledge, Practices and Beliefs of Women

The practices of women were divided around three factors (i.e. socio-cultural, economic and
environmental aspects). The questions related to demographic information, menstrual knowledge,
cultural and religious restriction(s), preferences for choosing different products, disposal practices,
and food preferences were added in the survey questionnaire and FGDs. The data was on the
aforementioned variables was collected from women through house-to-house visits as well as through
online data collection. During the household visits, the online data was completed but in areas where
access to internet was disturbed due to floods, paper-based questionnaires were administered. The
questionnaire(s) for women and men are attached in Annex I. In this, a total 3089 women participated
in the study including survey participants (2751) and FGDs participants (338) from four provinces.
1.3.2 Beliefs, Knowledge and Willingness of Men

In addition to the views of women, this assessment took into consideration the beliefs and knowledge
of men regarding menstruation and the associated disposal practices and their willingness for buying
sanitary pads. For this, in Karachi city, 3 FGD with men‘s group was conducted instead of KIIs which
was done in other cities. In this, a total 135 men were included to get their view point. The
questionnaire for men is attached in Annex I.
1.3.3 Shopkeepers
For this assessment, interviews with shopkeepers were conducted in all 12 cities. In this, a total 182
shops were visited including 78 shops in six cities of Punjab (Faisalabad, Multan, Muzaffargarh,
Lahore, Rawalpindi and Islamabad) 17 in two cities of KPK (Peshawar and Haripur), 55 in Sindh
(Dadu and Karachi) and 32 in Baluchistan (Quetta and Pashin). In all cities, 3 to 4 major markets
representing the overall city sample were selected. Shops in the areas where FGDs and house-to-

house visits were conducted were also visited to assess the availability of the products and their costs.
The questionnaire for shopkeepers is attached in Annex I.
1.3.4 Manufacturers
Discussions with Manufacturers were conducted to assess their viewpoint on production of
biodegradable material. The questionnaire for manufacturer is attached in Annex I.
1.4. Quality Assurance and Data Analysis
 For conducting FGDs and interviews with women, university and college administrations were
contacted and focal persons (student/teachers) were requested to assist the teams in data collection
in classrooms, university, colleges/school cafeteria and students‘ hostels. In some areas, due to the
closure of universities, the teachers were requested to assist by sending the online questionnaires
to classroom WhatsApp groups to submit the data. It was done through female faculty members.
To ensure the submissions, the liaison with teachers and volunteers with the dashboard operator
was kept closed to ensure the targeted number of questionnaires submissions.
 During different visits in the communities, permission was obtained from the community (elders)
by engaging the local enumerators which knew the context well in different communities.
 Permission was obtained from parents/guardians when surveying students, girls during house-to-
house visits.
 Briefing/training sessions were held for the enumerators to ensure quality, consistency and
compliance.
 The enumerators used paper-based questionnaires as well as online submissions depending on the
situation of internet access in cities/ communities.
 The data collected on papers was entered. Data was cleaned and analysed in Microsoft Excel.
 Data was arranged as per themes once the cleaning was done.
1.5. Teams
In all 12 cities, data collection teams were oriented on all of the questionnaires. Local organizations
working with communities were also engaged to collect the data based on their expertise in MHM and
WASH. The practices and demonstrations on questioners were conducted before data collection
during the trainings.
1.6. Study Challenges

There were multiple issues faced during the studies, which have been outlined below:
 The rainy season and flood situation was a major challenge in all four provinces to get access to
local communities or data collection. The communities often expected that the data collection
teams were part of relief teams and were engaging the communities for funds, etc.
 Online coordination was difficult due to the disrupted services of phone and internet in many
areas.
 Constant changes were made in the selected cities due to the access difficulty to communities and
respondents.
 The sensitivity of the topic took additional time in rapport building as the respondents were not
always forthcoming or comfortable about discussing the subject. For instance, in many cases the
focal points at universities were male and information (questionnaires) were shared with them, but
the response was very slow as they coordinated with female teachers to share the questionnaire
with female students.

 Discussion with shopkeepers in some areas was also difficult as they were not willing to provide
information or to hold discussions with female research teams.
 The heads of household (mostly male) did not participate with enthusiasm and often questioned
the rationale of the assessment.
 The response from some females was also varied. Some female teachers in the universities were
unwilling to share their views and personal information despite reassurance that the information
would not be shared.
 The questionnaires were shared with very wide audience in all 12 cities. However, the responses
were achieved after multiple reminders and requests which consequently delayed the analysis.
2. Literature Review
Menstrual health and hygiene is a major public health and social concern in Pakistan. Due to a lack of
infrastructure to provide education, healthcare and communication, as well as religious teachings,
menstruating women and girls are excluded from participating in many activities of daily living and
community activities. Evidence-based research on menstrual health and hygiene in Pakistan is not
widely available. The reference review covers the overall situation in the field of menstruation,
reviewing the current knowledge and practices of menstrual health and hygiene with regard to socio-
economic and ecological perspectives in Pakistan based on the work done by some of the local and
international organizations in Pakistan.
2.1. Importance of Menstrual Hygiene
To manage menstruation hygienically and with dignity, it is essential that women and girls have
access to water and sanitation. They need somewhere private to change sanitary cloths or pads; clean
water and soap for washing their hands, bodies and reusable cloths; and facilities for safely disposing
of used materials or a clean place to dry them, if reusable. There is also a need for both men and
women to have a greater awareness of good menstrual hygiene practices. Menstruation is a natural
process, but in most parts of the world it is taboo and rarely talked about. It has also been largely
neglected by the WASH sector and other sectors focusing on sexual and reproductive health, and
education. As a result, the practical challenges of menstrual hygiene are made even more difficult by
socio-cultural factors and millions of women and girls continue to be denied their rights to WASH,
health, education, dignity and gender equity.1
2.2. Global Perspective
Globally, women constitute 49.6% of the population.2 Menarche, or the commencement of

menstruation, is one of many intricate physical changes that take place as female ages from infancy to
young adulthood. The average woman menstruates from the age of 13 years to 51 years. Menarche
and menstruation are physically natural processes, but they are influenced by a wide range of
sociocultural ideas, attitudes, and behaviours. According to the WHO/UNICEF Joint Monitoring
Programme 2012, menstrual hygiene management is defined as:
―Women and adolescent girls are using a clean menstrual management material to absorb or collect
menstrual blood, that can be changed in privacy as often as necessary, using soap and water for
washing the body as required, and having access to safe and convenient facilities to dispose of used
1
https://washmatters.wateraid.org/publications/menstrual-hygiene-matters
2
(World population, 2020). Bologna, M., & Aquino, G. (2020). Deforestation and world population sustainability: a
quantitative analysis. Scientific reports, 10(1), 1-9

menstrual management materials. They understand the basic facts linked to the menstrual cycle and
how to manage it with dignity and without discomfort or fear.‖3
Women in low- and middle-income nations typically lack access to resources, particularly when it
comes to menstruation-related hygiene difficulties, in addition to having poor information about
menstruation. More than half of women globally are of reproductive age, yet many lack access to
menstrual hygiene products or sanitation facilities. Myths and stigmas surrounding menstruation
cause some women and girls to miss school, work or go into isolation. USAID recognizes MHM as a
vital part of the health and dignity of women and girls, and provides support to implementing partners
to address needs in this area.4
On daily basis adolescent girls discover blood on their clothing for the first time in settings without
toilets, water, or a supportive teacher, mentor, or role model to help them understand the changes
happening in their bodies.5 However, the physiological basis of menstruation, biological changes at
puberty, and the menstrual cycle, infection risks posed by poor practices, and the material disposal
options available to girls are not addressed or supported through open dialogue.6 The silence
surrounding this subject burdens young girls by keeping them ignorant of this natural phenomenon.
Some studies show that mothers feel reluctant and shy to share the information with their girls due to
socio-cultural and religious misconceptions and proscriptions.7
In order to raise awareness, May 28 is celebrated as ‗Menstrual Hygiene Day‘ around the world to
combat stigmas about the vital role MHM plays in ensuring health, dignity, and opportunity for
women and girls.8 In many cases, the mothers and the older women or teachers themselves are not
fully aware of the biological facts of menstruation or the good hygienic practices required, instead,
they pass on cultural taboos and restrictions to the young girls and the cycle continues from one
generation to another.9
In many societies, African and specially the South Asian, menstruation is framed as a process that
should be kept private and secret from men. According to multiple researches, mothers are the
primary source of information for girls about menstruation along with peers and some school-based
programmes. The knowledge of young boys on menstruation is limited and girls have to keep it
secret. Due to lack of knowledge, menstruation is attributed to negative social and cultural beliefs
which show an embarrassing moment for a female during menstruation. This lack of knowledge
3
Sahin, M. (2015). Guest editorial: tackling the stigma and gender marginalization related to menstruation via WASH in
schools programmes. Waterlines, 34(1), 3-6.
4
Hammed S, Larsen-Reindorf RE (2020) Menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene
management in Ghana: Evidence from a multimethod survey among adolescent schoolgirls and schoolboys. PLoS ONE
15(10): e0241106. https:// doi.org/10.1371/journal.pone.0241106
5
Sommer M, Sahin M. Overcoming the Taboo: Advancing the Global Agenda for Menstrual Hygiene Management for
Schoolgirls. Am J Public Health. 2013; 103(9):1556–9. https://doi.org/10.2105/AJPH. 2013.301374 PMID: 23865645
6
UNICEF. Sharing simple facts: Useful information about menstrual health and hygiene. New Delhi, India: UNICEF India;
2008.
7
hah V, Nabwera HM, Sosseh F, Jallow Y, Comma E, Keita O, et al. A rite of passage: a mixed methodology study about
knowledge, perceptions and practices of menstrual hygiene management in rural Gambia. BMC Public Health. 2019;
19(277):1–15.
8
https://www.globalwaters.org/resources/menstrual-health-and-hygiene
9
WaterAid. Is menstrual hygiene and management an issue for adolescent school girls? WaterAid/Anita Pradhan A
comparative study of four schools in different settings of Nepal [Internet]. Kupondole, Lalitpur, Nepal; 2009. Available
from: www.wateraid.org/nepal

contributes to stereotypical beliefs, negative attitudes, and general discomfort. Knowledge can
facilitate comfort and to facilitate open discussion, and openness can facilitate cultural positivity.10
Agenda 2030 on ‗Sustainable Development‘ promotes a holistic approach to development and

emphasizes the need to leave no one behind. In many countries, especially African countries, period
poverty or poor MHM as a barrier to access education and health due to inability to afford sanitary
products.11 A study of 235 girls in Ghana revealed that the girls felt their traditional cotton pads were
an unreliable protection technique for a full school day.12 Similar results were seen in Kenya, where
girls claimed to limit their activity during their periods and preferred to stay in to lessen discomfort
and prevent humiliation from monthly leakage.13 Girls are unable to manage their menstruation
hygienically due to lack of appropriate hygiene facilities, resources and education in Zimbabwe's rural
areas, where sanitary products are frequently unavailable and extremely expensive.14 Poor menstrual
hygiene practices also exist in Nigeria, as they do in the majority of developing nations, as a result of
ongoing issues with parents' failure to provide adolescents with sanitary napkins, mothers' lack of
education regarding good menstrual hygiene, and lack of time for practicing it.15 Similarly, 20% of a
sample of 351 Ugandan girls reported skipping at least one day of school while they were having their
last menstrual cycle.16 In an Egyptian study, bathing was considered unhealthy since it either
prolonged the bleeding period or stopped menstrual flow and resulted in skin macerations. Instead of
changing the pad as it became wet, most of the women changed their pads once or twice throughout
the day, either in the morning, evening, or at night.17
Menstruating women in India were reportedly prohibited from engaging in daily tasks like cooking
and serving food.18 About 50% of the women in South India abstain from perineal care and showering
while they were menstruating. Poor cleaning practices and the notion that taking a shower would
make the discomfort more severe and stop the menstrual flow were cited as the reasons for this
abstention.19 Similar restrictions apply to women's living arrangements in some regions of India and
Nepal, where they must dwell in a separate area of the home from the rest of the family. According to
data from a study carried out in Bangladesh, only 42% of females who reused the same cloth for
blotting up bleeding dried it in the sun; the remaining 82% did so in secrecy.20 The stigmatized status
of menstruation has detrimental consequences for girls‘ and women‘s self-esteem, body image, self-
10
Erchull, M. J. (2020). ―You Will Find Out When the Time Is Right‖: Boys, Men, and Menstruation. The Palgrave
Handbook of Critical Menstruation Studies, 395-407.
11
Akibinga, E. & Rukuba-Ngaiza, N. (2021). The Role of Law in Addressing Poverty and Inequality in High Income
Countries: A Comparative View of Menstrual Hygiene Management and Its Impact on Education and Health in the UK and
Select High Income Sub-Saharan African Countries. Law and Development Review, 14(2), 503-549
12
Dolan, C. S., Ryus, C. R., Dopson, S., Montgomery, P., & Scott, L. (2014). A BLIND SPOT IN GIRLS'EDUCATION:
MENARCHE AND ITS WEBS OF EXCLUSION IN GHANA. Journal of International Development, 26(5), 643-657.
13
Jewitt, S., & Ryley, H. (2014). It‘sa girl thing: Menstruation, school attendance, spatial mobility and wider gender
inequalities in Kenya. Geoforum, 56, 137-147.
14
Mavudzi, M. (2015). Menstruation Nightmare for poor rural girls. Extraído el, 7.
15
Folaranmi, Z. B., Titiloye, M. A., & Arulogun, O. S. Knowledge and Menstrual Hygiene Practices among Adolescent
Female Apprentices in Lagelu Local Government Area, Ibadan, Nigeria.
16
Miiro, G., Rutakumwa, R., Nakiyingi-Miiro, J., Nakuya, K., Musoke, S., Namakula, J., ... & Weiss, H. A. (2018).
Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study. BMC
women's health, 18(1), 1-13.
17
el-Shazly, M. K., Hassanein, M. H., Ibrahim, A. G., & Nosseir, S. A. (1990). Knowledge about menstruation and practices
of nursing students affiliated to University of Alexandria. The Journal of the Egyptian Public Health Association, 65(5-6),
509-523.
18
Bharadwaj, S., & Patkar, A. (2004). Menstrual hygiene and management in developing countries: Taking stock. Junction
Social, 3(6), 1-20.
19
Czerwinski, B. S. (2000). Variation in Feminine Hygiene Practices‐as a Function of Age. Journal of Obstetric,
Gynecologic, & Neonatal Nursing, 29(6), 625-633.
20
Matthews, K. A., Caggiula, A. R., McAllister, C. G., Berga, S. L., Owens, J. F., Flory, J. D., & Miller, A. L. (1995).
Sympathetic reactivity to acute stress and immune response in women. Psychosomatic Medicine, 57(6), 564-571.

presentation, and sexual health21, Menstrual education is a valuable opportunity to provide girls with
a more accurate, positive, and embodied view of their genitals to access as they develop a sexual
sense of themselves.
2.3. Pakistan’s Layout Regarding MHM
There are various factors which have been reported that influence the execution of MHM
significantly. Currently, Pakistan has some working group members from different partner
organizations including national and international to sensitize the government regarding MHM policy
in all provinces. But it would be a long way to achieve this as the liaison and sensitization of
government officials and frequent changes in bureaucracy has a big challenge to ensure MHM policy
and Agenda. The initiatives by multiple partners are done at their individual capacity to improve the
situation of communities but their sustainability still remain dependent on the government
implementers in the long run. There are different factors highlighted in different studies conducted by
organizations in Pakistan MHM sector.
2.3.1 Social Factors

The menstruation process is always mentioned in vague, undefined terms and never spoken of
directly. The national policies on health, education, youth, and sanitation do not fully addresses
MHM. Lady health workers (LHWs), the largest group of community-based healthcare providers in
Pakistan, have not been trained to provide information to adolescent girls or their mothers regarding
any aspect of MHM. A study conducted (Learning, acting, and learning (LAL) research on schools)
showed that the Government Education Department officials interviews were unanimous in their
opinion that this topic had never been discussed in any of their planning meetings, throughout the
extent of their careers. They had many misconceptions about menstruation and tended to
underestimate the need for the provision of MHM facilities. The reasons for their indifference
included: considering MHM way below their level of professional expertise, lack of knowledge about
the type of facilities required for MHM and the fact that no policy document has ever referred to
provision for MHM facilities.22 The current flood situation in Pakistan 2022, the relief kits containing
menstrual hygiene products were mocked on social media that the affectees need help not these
product by portraying the perception that menstruation management is not a fundamental right23.
2.3.2 Economic Factors

In Pakistan, women are more likely to drop-out of school or job and have more urinary tract infections
because of the difficulty in obtaining high cost of sanitary pads.24 According to a study done in
Pakistan, women feel more comfortable using homemade or cloth pads than commercial ones, which
is why sanitary pads are not used more frequently. It was discovered that 82% of Punjabi and 65% of
Sindhi women preferred to use homemade pads, whereas 15% of Sindhi women used no material at
all. To stop bleeding, they frequently switch out the pants.25 A dominant majority reported using old
cotton cloth as a sanitary napkin. It is folded in many layers and then placed inside the underpants or
21 Ingrid Johnston-Robledo and Joan C. Chrisler, 2020, The Menstrual Mark: Menstruation as Social Stigma - The Palgrave
Handbook of Critical Menstruation Studies - NCBI Bookshelf (nih.gov)
22 Naeem, K., KLAWITTER, S., & Aziz, A. (2015). Learning, acting, and learning (LAL) research on schools' menstrual
hygiene management (MHM): Pakistan. Waterlines, 103-112.
23 Ullah.T. Sep 21, 2022, https://www.thenationalnews.com/world/asia/2022/09/21/pakistan-floods-women-struggling-to-
secure-sanitary-products/ (Khyber Pakhtunkhwa), Pakistan, https://time.com/6213181/period-poverty-pakistan-
menstruation-floods/
24 Garg, R., Goyal, S., & Gupta, S. (2012). India moves towards menstrual hygiene: subsidized sanitary napkins for rural
adolescent girls—issues and challenges. Maternal and child health journal, 16(4), 767-774.
25 Khan, T., Qureshi, M. S., & Siraj, M. (1998). Patterns and perception of menstruation. National research institute of
fertility control Pakistan secretariat, Karachi.

is tied with a nala (a traditional woven string). Almost all of the girls reported reusing this cloth, after
washing and drying it. Some girls (around one-fifth of the total) reported using commercially
manufactured sanitary napkins during the first couple of days, especially during school hours. An
extensive analysis of the literature reveals that menstruating women in Pakistan are hindered from
properly observing hygiene procedures by traditional conventions and false beliefs, which are often
coupled by deplorable socioeconomic conditions.26 Period poverty is a severe issue around the world
and so in Pakistan and it extends beyond just the financial discrepancies that hinder women from
having access to proper menstrual products and extends into a ―social period poverty‖ wherein
women are deprived of education about menstruation.27
2.3.3 Environmental Factors

Adverse impacts of lack of MHM practices on environment cannot be ignored. Studies conducted by
IRSP, UNICEF, Water Aid, etc. show that almost all of the girls reported that availability of sanitary
napkins in schools and disposal facilities for the used sanitary napkins were absent. They reported
resorting to wrapping and throwing used sanitary napkins in the jungle adjacent to school or in the
corner of the school grounds, leaving them lying on the latrine floor and taking the used napkins home
in a plastic bag and then burning or throwing them away. The calamitous floods that have washed
over one-third of Pakistan have left millions of people displaced and vulnerable to hunger, waterborne
illnesses and other health concerns — women and girls, in particular. The United Nations Population
Fund estimates more than eight million women and girls of reproductive age have been affected by
the flood, with 1.6 million in need of humanitarian assistance.28
2.4. Available Studies from Pakistan
There are around 600 million adolescent girls globally, and more than 42 million (roughly 22%) girls
in Pakistan are aged 10 to 19 years. Some of the available studies include the work of local and
international organizations from 2010 to 2021. The highlights from these studies are detailed below:
2.4.1 IRSP Studies

During 2010 flood emergency, IRSP provided sanitation pads, clothes and other sanitary products and
educated females to manage their menstrual cycle easily. IRSP also worked on an important issue of
menstrual waste disposal during the emergency and in routine life. Menstrual waste disposal was
absolutely improper in camps and even in houses of flood affectees. Improper disposal of used
material can lead to various kinds of infections IRSP planned for an advocacy campaign to address
the issue of MHM. A study by Integrated Rural Support Programme (IRSP) found that 66% of the
girls/women used cotton or a piece of cloth during menstruation, and only 17% used a sanitary pad;
30% did not wash their hands after changing the menstruation cloth; 49% reused the menstruation
cloth. 29
2.4.2 UNICEF Studies

UNICEF conducted learning, acting, and learning (LAL) research in schools30 on menstrual hygiene
management which reflected that girls (around one-fifth of the total) reported using commercially
produced sanitary napkins. They found these pads were more absorbent and convenient for managing
heavy blood flow. Most of these girls reported using commercial napkins during the first couple of
26
Mutunda, A. N. N. E. (2013). Factors impacting on the menstrual hygiene among school going adolescent girls in Mongu
district, Zambia. School of Public Health. University of the Western Cape, 1-81.
27
https://borgenproject.org/period-poverty-in-pakistan
28
https://pakistan.unfpa.org/en/news/women-and-girls-bearing-brunt-pakistan-monsoon-floods
29
Menstrual hygiene management in schools in South Asia- Country Snapshot
30
Conducted by UNICEF in 2013-14 in Punjab and KPK and formally published in January, 2015

days, especially during school hours. The research also revealed the non-availability of sanitary
napkins at schools and disposal facilities of used sanitary napkins. The school girls reported wrapping
and throwing used sanitary napkins in the bushes adjacent to the school or in the corner of the school
grounds, leaving them lying on the latrine floor, or taking it home in a plastic bag and then burning or
throwing it away.
UNICEF conducted advanced research on menstrual hygiene management among girls in schools in
Punjab and KPK.31 Based on research findings, developed MHM Kit, MHM monitoring tool, and
Behavioural change communication (BCC) material and rolled it out in six schools through an
implementing partner, Rural Support Programme Network RSPN. Additionally, UNICEF developed
and strengthened a mechanism for the availability of MHM supplies such as commercially prepared
sanitary napkins, underpants (cotton, medium size), brown paper bags, and soaps in schools. The
MHM supplies are accessible to the students on cash or credit whenever needed. A designated teacher
monitors the MHM supplies sale and replenishes the stock accordingly. Additionally, UNICEF also
introduced the MHM Pack, a small bag (plastic or cloth) with a zipper containing a commercially
prepared or homemade sanitary napkin, a small soap, underpants, a small pack of pocket tissues, and
brown paper bags. Girls were educated to keep it in their school bags. Plastic dustbins with lids were
introduced for disposal and brown bags for final disposal, a pit was dug in a designated corner of the
school ground. Another formative study32 on girls in rural and urban Balochistan and Sindh identified
six following key themes:
 Menarche as a traumatic event;
 knowledge and normalization of pubertal changes;
 cultural information, sceptical acceptance;
 information needs and concerns;
 quality of WASH facilities does not meet girls' menstrual hygiene needs; and
 characteristics of ‗Girl-Friendly‘ school facilities.
UNICEF conducted an online poll of more than 700 girls in 2017 in all over Pakistan. The results33
indicated that 49% had no knowledge of menstruation prior to their first period. Also, mothers and
teachers (53% and 27% respectively) were the primary sources of information on menstruation for
girls. 0.9% of the respondents also rated the Internet including YouTube as sources for information.
The poll further revealed that 44% of the girls do not have access to basic menstrual hygiene facilities
at home, their workplace or school.
2.4.3 WaterAid Studies

WaterAid conducted technical assessment of incinerators to support Girls' WASH Programming in
2018 in Muzaffargarh, Punjab. WAP contracted DevTrio Consultants (DTC) and Geolinks Private
Limited (GPL) to conduct a technical assessment focused on the incinerators that are integrated into
girls' friendly toilets in Muzaffargarh district. The technical assessment revealed that the incinerators
that WAP had integrated into the project were helpful in disposing of menstrual waste in a manner
that mitigated the more harmful effects of cheaper alternative options, such as open dumping or deep
burial while incineration is not optimal for commercial menstrual waste which contains plastic and
PVCs that are generally not biodegradable. Based on international and national standard guidelines
for incineration, seven categories of findings and recommendations were developed in order to
31
Advanced Research on Menstrual Hygiene Management Among Girls In Schools Phase-lll, June 2014 by UNICEF
32
UNICEF and Real Medicine foundation conducted FORMATIVE Menstrual Hygiene Management Research: Adolescent
Girls in Baluchistan, March 2016
33
Breaking Silence on Menstrual Hygiene-Amplifying youth voices to tackle myths and taboos surrounding menstrual
hygiene by UNICEF

improve the incineration design and process for future scale-up of the project regarding construction
design (for quick burning, higher temperatures and complete combustion of menstrual waste), safety
to equip schools on MHM friendly toilets and their sustainability, operations (schools waste tracking
system to develop a consistent burning system/schedule on weekly or monthly basis), maintenance
(ensure the usage of inclinators at their full capacities) provide relevant trainings, and ensure the
compliance mechanism for sustainability of untaken initiates.
Water Aid Pakistan also conducted a market study and mapping of existing supply chains of MHM
product in 2021. The market study and mapping of existing supply chain of menstrual hygiene
products was a sub-set of a larger Water Aid 3-year HerWASH project. The HerWASH project
mandate was to address MHM issues for women and adolescent girls (in school and out-of-school) in
district Thatta, Sindh. The market study aimed to assess the availability of materials and facilities for
the appropriate menstruation management in rural tehsil Mirpur Sakro of district Thatta, focusing on:
 Availability of menstrual hygiene products:
 Existing supply sources of such material:
 Gaps in the existing supply chain, demand, access and challenges faced by adolescent girls and
women; and
 Availability of sanitary/MHM product through formal and informal means, including service
providers and entrepreneurs.
The study shares that use of disposable pads was common in school going age girls. Regarding
changing of the material the girls reported to change the used material 2 to 3 times in a day whereas
during heavy bleeding it is much frequent. But on the level of satisfaction around 79% of school girls
expressed complete dissatisfaction regarding the comfort of available products. Many of the products
have limited absorption capacity and therefore end up leaking. Brand Preferences and Pricing of
Menstrual Hygiene Products: In the case of pads, three brands are most popular in Mirpur Sakro. 90%
of respondents said they sell Always products, 57% of respondents also keep butterfly products,
whereas 23% of respondents keep Right products. Other brands are available with only a few of the
bigger retailers and wholesalers.
2.5. Initiatives to include MHM in Educational Curriculum
2.5.1 Educational Materials

The national curriculum does not cover MHM; life skills education is only taught at the primary level
(grade 1-5) and does not refer to MHM while middle and high school classes do not cover MHM
sufficiently. The non-governmental organisations (NGOs) and private sector actors are conducting
awareness sessions in schools to educate and inform girls and teachers about MHM. MHM is included
in the Lady Health Worker (LHW) curriculum in Punjab and Khyber Pakhtunkhwa. However, LHWs
are generally not allowed to talk to young girls or adolescents because their function is associated
with family planning. Numerous agencies have developed various MHM information and education
materials (IEC), particularly UNICEF, for teachers, students, LHWs, and school health and nutrition
supervisors.
2.5.2 MHM in Schools’ Practice

WaterAid Pakistan implemented a project, Ensuring girls' rights through school-based WASH and
improved menstrual hygiene management in 106 schools, funded by UK Aid from November 2014 to

March 2018.34 The end project review reflects a great success in breaking the silence around
menstruation, including at household level, improving hygiene practices amongst girls and increasing
girls' attendance in school. Both infrastructure and pads provision in schools have had a significant
impact, but their view pointed out that the systems set up are well suited for disposable pads users but
could be improved to cater for the needs of girls using cloth. The construction of incinerators had a
good impact on handling used pads, but the end project review observed challenges with
functionality, environmental impact, and cost. The project contributed to increasing the affordability
of pads for schoolgirls, but the affordability of disposable pads remains a vital issue for low-income
school girls. National and provincial MHM groups have designed strategic plans to induce a
behavioural change in parliamentarians and allocate resources for MHM in the WASH sector. At the
school level, the impact was limited by the small number of students trained compared to the overall
student population and focal teachers only.
2.6. Coordination Platforms/ Mechanisms
In on-going Pakistan initiatives, the national MHM Working Group (WG) was formed along with the
sub-national working group in three provinces – all comprised of UN, NGOs and government
agencies. UNICEF chaired the national MHM WG on a yearly rotational basis. During their tenure,
they developed MHM WG terms of reference (ToRs) and were endorsed by the members. A visioning
exercise was conducted in the light of the recommendations of the visioning exercise members, and
MHM intent paper was developed, which defines MHM's vision for Pakistan, including strategies and
key activities. Subsequently, a work plan was developed and endorsed by the MHM WG. MHM has
been integrated with the flagship Sanitation program (PATS+) and explicitly included in all capacity
building, awareness, training, and infrastructure improvement interventions. MHM was incorporated
in "Minimum Standards for Quality Education" by the Education Ministry at the Federal level to
improve the educational institutions' learning environment. MHM Mainstreaming in WinS strategies
with a particular focus on the inclusion of MHM and girl-friendly toilets as an essential aspect in
minimum standards for WASH in Schools as well as the inclusion of MHM aspects in regular
monitoring mechanisms, e.g., EMIS.
2.7. Use of Social Media
Uzma Kardar, a member of the provincial assembly (MPA) and chairperson of the standing
committee for gender mainstreaming and women's development in Punjab, highlighted that she
learned that 15% of the population in Punjab and 43% in Rajanpur defecate in the open while working
with Water Aid and Strengthening Participatory Organization (SPO). Moreover, the minister assured
that the finalized sanitation policy, including MHM and its implementation, will be in the next budget
when MPA enquired about the status.35
Water Aid built the capacity of females and teachers on menstrual hygiene and to make sanitary
napkins, documentary on ―Her Hygiene matter,‖ about a successful sanitary napkin-making
entrepreneur and animation on MHM ―Aao Baat Kareen‖ the animation reflects the availability of
MHM material in school, allowing girls to freely and confidently attend school and reducing absentee
and dropout.36
34
Ensuring girls‘ rights through school-based WASH and improved menstrual hygiene management (MHM) in Nepal and
Pakistan-2018
35
Access the address at: https://youtu.be/md8sRIdGaxg.
36
Video/ content accessible at: https://youtu.be/ycvm30fozTc.

Demographics
This section includes the demographic information including the overall respondents, their education
levels and status as well as parent‘s education and their professions. The information on heads of
households and shopkeepers on supply side is also included in this section.
3.1. Number of Respondents
A total of 3089 women participated in the study responding either through survey questionnaire
(2751) or through participation in FGDs (338) from four provinces. Overall, 12 cities were selected
including (Rawalpindi, Islamabad, Lahore, Muzaffargarh, Multan, and Faisalabad) from Punjab,
Haripur and Peshawar in Khyber-Pakhtunkhwa (KPK), Karachi and Dadu from Sindh and Quetta and
Pashin from Baluchistan. Population from urban, semi urban/rural population was focused on to
collect the data from all cities. In survey questionnaires, 39% respondents were from Punjab along
with 24% in KPK, 21 % in Sindh and 17 % in Baluchistan as also depicted in Figure 1 below.
2751
1079
649 565 458
Punjab KP Sindh Balochistan Total
Figure 1: Number of Respondents
Along with survey, FGDs were also conducted in all cities. The inclusion was prioritized to get the
opinion from different groups of communities based on education, profession, religious and disability
status to ensure the participation of all groups.
Table 1: Number of FGDs and Participants

Household Working No. of
Province Minority/ Disabled Students No. of FGDs
women women Participants
Punjab 3 3 3 5 14 143
KPK 1 1 1 5 8 68
Sindh 2 2 1 1 6 57
Balochistan 2 1 2 2 7 70
Total 8 7 7 13 35 338
In all cities, a total of 35 FGDs were conducted including 8 with minority and disability groups, 7
with household women (mothers and elderly women groups and young married women being
housewives), students studying at different universities, colleges and schools37 in selected cities and
provinces. The students were selected from different types of departments/disciplines to understand
the varied nature of their understanding on socio-cultural, health and ecological issues that were
directly linked with the questionnaire categories on socio-cultural beliefs, environmental aspects,
health aspects and economic aspects. It was interesting to see the variations in responses as the natural
and environmental sciences groups were more familiar on health issues, composition of pads material,
37
Discussion in schools in Muzzafargurh with students and teachers on existing initiatives of NGOs/INGOs and Karachi
city.

disposal issues and its environmental aspects as compared to social sciences groups. On the other side,
medical and environmental, sociology/anthropology students were also more open to discussion on
pads as compared to social sciences groups from management related disciplines like economics and
statistics.
3.2. Types of Respondents
3.2.1 Respondents from Survey

Among all the cities, data was collected from three types of respondents. The 55% respondents are
students, 29% are household women and 16 % are working women. The household women data
obtained both ways through house-to-house visits and sharing the online form on different groups and
forums through forward requests on WhatsApp, emails and social media platforms. In student
categories, students‘ data from social sciences, natural sciences departments and medical colleges in
different universities (list of universities attached) was collected. Among working women, women
working in universities, teachers, government offices, working in NGOs, medical profession, and
business women completed the survey. The breakdown is further elaborated in Figure 2 below.
1524
787
440
Household students Working Women
Figure 2: Type of Respondents
3.2.2 Number of Respondents in FGDs

A total of 338 respondents participated in FGDs including 25% from minority groups, 20% household
women, 20% working women and 35 % students. The minority group included the mixed groups such
as household community women, working women and students.
Table 2: Types of Respondents in FGDs
Minority/ Household Working
Province Students No. of Participants
Disabled Women Women
Punjab 35 28 29 51 143
KPK 8 10 8 42 68
Sindh 20 21 10 6 57
Balochistan 20 10 20 20 70
Total 83 69 67 119 338
3.3. Male Household Head/Guardian Education
Regarding the education of the male guardian (father/husband) of respondents, 34 % were illiterate
while 47 % had education from primary to secondary and 20 % had graduation and above level
education. The highest number of parent‘s illiteracy was found in Pashin (father 51%, mother 82%)
and Dadu (father 60%, mother 76%). Whereas, the highest education level was found in Islamabad

(father 35% and mother 18%) and Peshawar (father 31% and mother 8%) and Lahore (father 22% and
mother 16%). In Peshawar city mother‘s education was less as compare to father.
34%
20% 14% 21% 17%

19% Father
15% 16%
13% 11% Mother
9% 8%
1%
2%
Illitrate Primary Middle Matric Secondry B.A M.A & above
Figure 3: Education Level of Parents
3.4. Parents/Guardian Occupation
Regarding the occupation, 23% had government jobs, 25% owned business, 28% were labours,
mechanics, electricians and drivers, 18% held private sector jobs, 3% were involved in farming and
3% were unemployed (see Figure 4 for details). On the other side for female heads of households,
only 15% female heads were working including 5% government employ, 6% private jobs and 4% in
informal sectors (labour or working as tailors, household maids or labours etc.).
25%
23%
18%
16%
8%
3% 3% 4%
Farming Govt job Bussiness Private job Jobless Drivers labours others
Figure 4: Occupation of Fathers/ Guardians
3. Menstrual Knowledge
4.1. Pre Menstrual Knowledge
The study found that 72 % respondents had pre-menstruation knowledge whereas 28 % said they were
unaware when they got their periods first time. During the discussions, the pre knowledge ratio was
slightly different (40:60) as more respondents were unaware about menstruation at the time they got
their periods. Highest responses for women having premenstrual knowledge were from Baluchistan
(82%) whereas the lowest responses regarding pre knowledge was from Punjab (65%). A respondent
from Multan shared:
“I got my periods in the classrooms resulting in staining my uniform. I thought that I

got haemorrhoids just like my grandmother and will die. I burst into tears and cried
loud in front of the whole class. My teachers sent a message to my home asking my
mother to come and not my father. This made me worried even more. Later, my teacher
and mother normalized me by saying it is normal and every girl gets it. That was still
the most embarrassing moment for me.”
During the group discussions from all cities women and girls were also asked what they call periods
in their local language. Different names came up from different provinces. Among the students the
majority names are menses, periods or date. However different communities use different names in
their local languages like kapray,38 kaali, najori, surkh jhandi,39 mahwari, jamedeshai,40 mehman,41
zamana,42 maheenwalay43 and Guz,44 Tareekh, Baari45 Jama46 bimari and haiz.
72%
28%
Yes No
Figure 5: Status of Pre-Menstrual Knowledge
Regarding menstrual knowledge 100% women consider periods a source of reproductive health that
every woman goes through. It is considered as a symbol of womanhood. According to respondents,
without periods girls cannot reproduce and can never become a mother. The responses among
students and household women were different. The students from science disciplines were clearer and
provided more detailed answers regarding the duration of overall cycle. Some of the women were of
the view that it is an indication of good health and confirms the gender as well. In community worker
of local organization in Dadu shared:
“If girls don’t get their periods, it is considered as if they belong to the transgender
community. Transgender usually take such girls with them and that’s why girls fear
and hide in case of delayed period.”
Most of the women also told that it signifies that the girl is ‗becoming an adult‘. A student from
Quaid-i-Azam University shared:
“Periods provide a sense of happiness because it

confirms the gender of a person and is celebrated in
my community.”
In some cities, the mothers shared that when an adolescent girl gets her period, it is celebrated, while
in some other areas, especially in Muzaffargarh and Dadu, the mothers shared that these days‘ girls
get period little early, so they keep it secret from the household men as well as from the females in the
neighbourhood. This was mostly done to prevent early marriages of girls.
38
Karachi, Dadu
39
Pashin
40
Peshawar
41
Dadu
42
Dadu
43
Dadu
44
Hazara Community, Quetta
45
Islamabad
46
Kili Machan -Pasin

4.2. Source(s) of Information
The assessment found that the major source of information is television in all the cities. In this, only
4% respondents said that they used internet and social media and these respondents were from Sindh
(Karachi), whereas 1% respondent also shared radio and newspaper as a major source of information
on the subject of menstruation.
95%
1% 4%
Radio/News paper Internet Tv
Figure 6: Source(s) of Information
4.3. First Information Source on Periods
Five major categories for first source of information includes mother and family members, friends and
peers, lady health workers, NGOs, school sessions and media. Regarding the first time information,
72% respondent got information from family member (mostly the mother) on hygiene for managing
their periods. They called it most comfortable as compared to other sources. Along with mothers,
women from all age groups and occupations told that they also got information from their elder
sisters, aunts, friends, and grandmothers. Moreover, 18% respondents shared friends /peers as a
source of information, 3% respondents shared LHWs, books, school, NGOs sessions as their first
source of information, and 3% respondents (mostly students from Punjab University, Lahore)
mentioned that TV commercials and social media were also major sources of information regarding
menstrual hygiene and management. These findings are detailed in Figure 7 below.
72%
18%
6% 3%
1%
Family Friends LHWs School/NGOs Media
Figure 7: 'First' Source of Information on Menstruation
Discussion with LHWs and MHM community focal points in Pashin, Dadu and Muzaffargarh,
highlighted the role of NGOs, women youth centres for creating awareness on MHM. The sessions by
NGOs47 and LHWs sessions were mostly reported in semi-urbanised cities or rural areas. It was also
noted in the discussions with students that mothers were mostly reluctant to share knowledge about
menstruation as they ignored the curiosity of girls when asked questions on the subject.
47
Agha Khan, AGAHI, HANDS

Nonetheless, the respondents shared that now due to easy access of information available on TV
commercials the young girls know about it before their period. Moreover, different brands visit
schools in their hygiene campaigns for instance respondents from Quaid-i-Azam University, Karachi
University, Taxila and Haripur shared that Always Company visited their institutes and provided pads
during schools sessions. In Schools of Muzzafargurh water aid production units Pads were found in
some school hygiene kits but due the closure of units there was no supply.
4.4. Menstruation Age
The assessment determined that 79% of the respondents got their periods between the ages of 11 to
14. The responses were same in discussion with different groups in FGDs as well. In this, only 7%
respondents shared that they got periods at very early age (between 9 to 10 years). The highest
number reported at early age was from KPK 12% followed by Punjab 8%. Whereas, girls getting their
periods late (i.e. after 15 years) were 13% in which (20%) were from Balochistan. This could be
linked with premenstrual information as more women were aware about menstruation when they got
their periods from Balochistan. Opinion regarding menstrual age was also asked from the participants.
The respondents shared that menstruation has started to appear relatively early as compared to earlier
times. These days some girls at the age of 8 were also reported to get their period, but 9 to 10 years is
becoming very common. The respondents considered processed food as a major source with chicken,
meat and climate situation. Some respondent also shared that media awareness and children‘s access
to different types of materials in the absence of parent‘s guidance is also a major source for getting
early age periods. Some respondents also shared that they got their periods at a very late age. A
respondent in Multan shared the following personal insight:
“I got my periods after matriculation, and I was 16. My mother was worried and she
and I questioned my gender. But when I got periods we paid thanks to God and
distributed niaz (giving in the name of God for wish fulfilment).”
51%
28%
13%
7%
0.40%
9 to 10 11 to 12 13 to 14 15 to 16 17 & above
Figure 8: Age at the Beginning of Menstruation
4.5. Number of Menstruation days
Regarding the overall menstrual cycle, the awareness level was mix. Some considered the number of
menstruation days as their cycle and others counted it as per month (the whole cycle). Some
respondents shared the irregularities in their menstruation and found it difficult to discuss with family
member. The findings are detailed in Figure 9 below.

89%
4% 7%
3 to 5 day 5 to 7 days 6 to 10 days
Figure 9: Average Days of Menstruation
4. Menstrual Management Preferred Material

Multiple practices were identified in the qualitative and quantitative data findings. These include
cotton, use of new cloth, reusable cloth, pads, tissue papers, homemade pads baby pampers, menstrual
cup, Tampons and trousers (shalwar) as itself48. Menstrual cup was reported only by 3 participants in
FGDs from Islamabad and Muzzafargurh, Tampons were mostly reported in Islamabad and baby
pampers were shared in Faisalabad, Quetta and Pashin. In Muzzafargurh, in rural settings, women use
their trousers (shalwar) and reuse it multiple times with attached string and in some cases. A
community influential from Muzzafargurh shared that these days women, if not using sanitary pads
and underwear, at least use the cloth in proper way. She added that ten years back the practices were
to just wear shalwar and sit on the sand as women were not aware how to use cloth as a pad in
absence of underwear. Due to increasing awareness, the young girls have shifted to homemade pads
as taught by NGOs workers but the old practices still exist in some areas. Overall, practices show that
70% respondents use pads whereas 29% use either cotton or cloth (new and reusable) as shown in
Figure 10.
70%
8% 11%
4% 6%
0.20%
Cotton New cloth Reusable cloth pads Mix Pampers
Figure 10: Materials Used During Menstruation
The group discussion highlighted more details on the subject. The use of homemade cotton pad was
found at least among 2 to 3 students in all cities. They reported having lot of allergies and infections
by using pads. The homemade pads with the help of cloth and cotton were reported safer to control
infection in almost every discussion. Among the older women, they reported use of cloth, but
preferred their girls to use sanitary pads as it was safer when they are not at home to avoid stain and
embarrassment. In Dadu, it was noted that women use homemade pads and community women shops
also sell the pads made of cloth and cotton. The women shared that they had received trainings and
material at household and community level to make their pads with support from Agha Khan
Foundation.
48
The practice was found in three aspects use of shalwar (trouser) itself and changing it continuously. They shared that they have separate period’s shalwars 8
to 10 for managing their periods (Muzaffargurh). Where as in some case they were using nala for managing the cloth with trouser. In some cases the women
were using underwear and keeping the cloth pads inside the underwear.

The community level processing unit ―Sangat‖ in Muzaffargarh was also visited that produced the
pads in community by AGAHI and WaterAid for four years. But currently the unit is closed and
machinery is taken back. The school was also visited in Muzaffargarh where girl-friendly toilets and
pads‘ distribution was part of the project. But as per teachers, the communities were not well-aware
and pads costs were high so school girls mostly used cloth in rural areas. The teachers shared that
during project activities, they conducted sessions, but currently no sessions were being held due to
project closure. Household women in Pashin preferred to use cloth or diaper, but most of the working
women and students preferred to use pads during periods. It was shared that the use of cloth was
linked with safety from infection, easy disposal and religious prudency. Women from Muzzafargurh
and Peshawar shared that it was shameful to throw or dispose of pads outside home and no one except
spouse should see sanitary pads as per Islamic teaching.
5.1. Sanitary Pads Source of Information
Regarding the information on sanitary pads, multiple responses were received in which televisions
was highest with 61%, followed by LHWs at 28%, family and friends at 9%, schools and NGOs and
internet at 2%. The organizations highlighted included Hands, Agha Khan Foundation, AGAHI and
Water Aid Pakistan and UN agencies. Additionally, Always and Molpad was also reported for sharing
information on pads. My lady was found sharing information in Pashin and Quetta.
61%
28%
9%
2.00%
LHWs TV Family & Friend Schl/NGOs
Figure 11: Source(s) of Information for Pads
5.2. Preparations before Periods
It was noted in the assessment that mostly the respondents prepared before their monthly cycles
began. In this, 69% shared they prepared for menstruation and kept the products in bags to avoid
embarrassment. They shared that at home it is easy, but going outside at work or university they
always get prepared before the cycle. One of the Working Groups in Faisalabad in government office
shared that they do not have any shop or cafeteria for these products and if anyone gets their periods
they borrow it from other colleagues. So, for self-safety they always remained prepared. On this
subject, one respondent from Faisalabad shared:
“My periods are not regular. It keeps on changing every month due to fear I keep using
tissue papers to avoid embarrassment as many times toilets are not clean at college and I
have to keep myself prepared. This cause infection-related issues sometimes.”

69%
31%
Yes No
Figure 12: Status of Preparation before Periods
Respondents from Lahore City shared that they buy pads while doing their monthly groceries and do
their household chores before their periods. In Multan, women49 also responded that they make
preparations and get done with laundry so that they do not have to touch water. In Quetta, all the
respondents said that they make preparations before their periods in order to avoid the hustle. In
Dadu, most of the women responded that they do not make any preparation because the dates kept on
changing. They only make preparations when they have to travel or attend any function. Young girls
also responded by saying that their elder sisters make preparations for them. Some women also make
pads on their own in times of emergency.50 Most of the respondents from Multan, Faisalabad, Pashin,
and Karachi also take precautionary measures before periods especially when they have to go out for
work. A respondent elaborated their concerns about preparations as:
“I went to school and my uniform was white. Suddenly my menses started and the bench got ruined.
They called my parents who took me home and I was very scared as well as embarrassed. I went to
school after taking a leave for two days. Teacher guided me which calmed me down. I remember that
event very well and never go unprepared anywhere. Even if my period dates are not close, I keep myself
prepared by fearing so that I’m always prepared.”
5.3. Preferred Brand(s)
It was noted that there are more than 20 brands of sanitary napkins available in different cities
including Always, Trust, Sincere, Rahat, Anion, Molpad, Kotex, Tampax, Freedom, VIP, Mother
Comfort, Cleopatra, Golden, Active, Butterfly, Daisy, Suffena, Baby Pampers, Dove, local pads, My
Lady, etc. From these, it was found that Always and Butterfly were the most preferred brands as 48%
respondents reported to using Always while 18% shared they used Butterfly. Moreover, the use of My
Lady was only found in Pashin, Quetta whereas Suffena was found only in Multan and Muzzafargurh.
48%
25%
18%
4% 4%
Always Butterfly Molpad Mixed Others
Figure 13: Preferred Brands
49
Household and working women
50
In Johi Dadu, women were given training on making pads by Agha Khan NGO

Some respondent shared that they change one brand to other when one product is not available, and in
some cases due to infections. In some cities, the quality of some products was not same as reported by
consumers and this aspect was confirmed from the shopkeepers as well. The consumers called these
pads ‗Chinese copies‘. In Muzzafargurh , the shopkeeper shared that mostly, the shopkeepers know
about the quality due to consumer complaints and sometimes the distributers bring the low quality that
are not original and shopkeepers can identify it as they sell these on lower prices to other shopkeepers
but while receiving the same price as of the original pads from customers.
5.4. Reason(s) for Preference of Used Material
Different reasons were shared for choosing specific brands including comfort, safety (from infections
and stains), absorbance, easy disposal and minimum or no cost. In this, 51% respondents shared
satisfaction based on absorption, comfort, infection free, and safety during travel or inside home,
during sleeping at night, during work when changing pads is difficult, etc. Additionally, 48%
respondents shared preference of their choice material due to easy disposal whereas only 1% shared
the low price or no price as detailed in Figure 14.
1%
51%
48%
No Cost Easy Disposal Comfort and Safety
Figure 14: Reasons for Preference
Aside from the aforementioned reasons, it was found that some women prefer to have those pads that
do not have fragrance and which are available in all sizes and thickness and thin properties with
wings. In all discussion always and butterfly were the top used pads. A student from Peshawar
University shared:
“I prefer Always (brand) because it does not leak and it is easy to use; soft,
comfortable, free of tension from using a cloth.”
5.5. Pads Availability
The data on the availability of pads found that pads are available in 73% shops whereas 13%
respondents do not use pads and 14% do not know about it as mostly the shopping is done by family
members and they have no knowledge.
73%
13% 14%
Yes No Do not Know
Figure 15: Availability of Pads

5.6. Purchasing Source
Around 46% respondents shared that they buy pads for themselves mostly including the university
students and working women. They shared that in earlier period days it was difficult to buy pads but
due to work or studies, students get used to it for buying pads for themselves. They also shared that it
was routine usage and mostly on store the ‗brown paper‘ is available to cover the pads. In this, 37%
respondents shared that their parents (mostly mothers) buy pads for them. Some other members
including aunts, sisters, and friends were also reported to be purchase pads.
46%
37%
16%
1%
Self Parents Friends Other
Figure 16: Purchasing Source
During the discussions with school girls, students in Peshawar, Karachi and Pashin, said that their
mothers buy their pads because they feel shy buy themselves. Married women also responded that
their husbands buy pads for them, but in some cases either their mothers-in-law or they themselves get
pads. For instance, a respondent from Quetta shared that:
“I am not allowed to buy pads by myself my mother buys it for me.”
During discussions women were also asked about the labels of pads and language written on the pads.
Women from the Hazara community mentioned that they do not understand the labels or anything
because most of the time they are either in Arabic or English language. However, some women shared
that they can understand the pictures. Women in Karachi responded that they only understand when
the specification is in English otherwise Chinese language is not understood. Whereas, weomen from
Pashin (Killi Machan) shared that letters are too small to understand. On the student‘s side, they
mostly understand the labels and read the description before buying it. In Muzzafargurh , women
responded that they only look at the number of pieces before buying. Some respondents shared that
they do not read the labels as people can see them standing in the pads area, so buy it in hurry.
5. Health
6.1. Food Preferences
The discussions elucidated that mostly the respondents used warm food items during periods either in
form of drinks such as green tea, milk tea, soups, etc. However, among women in different
communities, different myths and practices were shared regarding milk consumption and meat. In
Muzzafargurh , Pashin, Dadu, Multan, Peshawar, Haripur, Rawalpindi, Multan in each group the
consumption of milk was not considered good due to impurity. And for meat, respondent shared that
it creates problems for women in future if they consume meat as Jin51 can attack the young girls if
they eat meat during period.
51
Mythical creature

Among students and working women, healthy diet consist of fruits, meat eggs, milk and its products.
Nuts and multivitamins were also reported to be consumed by some students. Students from
Islamabad responded that they take milk products in the form of milkshakes, tea, and coffee. All
women from the Hazara community, in Quetta, shared that calcium and low-fat milk is important
during period. One of the respondent from Peshawar shared that consuming cheese/milk can worsen
period cramps leading to bloating, gas, and diarrhoea. Most girls revealed they drink herbal mixed
boiled milk to reduce abdominal pain. The quantitative data shows that 69% women prefer warm
food, hot beverages, soups, green tea, and milkshakes. Whereas 20% shared that they crave for spicy
and sweet food during their period, 3% respondents do not prefer any food and eat as per availability
and 8% shared about appetite loss due to bloating, vomiting, pain issues.
69%
20%
8%
3%
Lose Appetite Milk products, Tea & No Choice Spicy & Sweets
Qahwa
Figure 17: Food Preferences during Menstruation
6.2. Types of Health Issues, Symptoms and Fears
Different types of symptoms and issues were reported during discussions as well as in the survey
questionnaire. This included body pain, bloating, vomiting, headache, abdominal pain, back pain,
headache, breast tenderness, bloating, fever, loss of appetite was reported by 44% participants.
Another 20% reported issues related to mental and emotional health including aggression, tension,
frustration, mood swing, low feeling, under confidence, hypertension, irregular blood pressure. While
9% respondents shared problems related to infection, rashes and allergies, travelling, difficulty in
performing routine work by feeling weakness, excessive bleeding, tiredness/fatigue and dizziness,
social with drawl, self-smelly feelings, shyness, fear of leakage and stain, under confidence and
difficulty in sleeping. A very small number shared about ‗bad feelings‘ as they are unable to perform
religious duties. Only 0.16 % shared that they face no issues during their periods. Most of the girls
responded by saying that itching and allergies, swelling, and rashes were the common difficulties
faced by them. In Haripur, a woman mentioned that the main problem is the availability of China
products which cause rashes and infection. Furthermore, gastric issues,52 leakage, and rashes due to
hard edges53 were also problems identified by women from different cities. Sharing their condition
during periods, respondents shared that:
“I have strong abdominal pain and vomiting to the extent that I faint and often go the hospital.”
“I always get rashes during my periods and feel difficulty during walking.”
52
A household woman in Multan mentioned this issue.
53
A response by the student of Quaid-i-Azam University.

44%
20%
9%
0.11% 0.16%
Pain Aggression Travelling Bad feelings No Issues

Figure 18: Types of Symptoms/ Health Issues during Menstruation
6. Costing
7.1. Pads Used Per Cycle
Different respondents shared that use of pads depends on blood flow. It was reported that in the first
2-3 days, the use was higher as compared to the later days. In this, 33% respondents shared that they
used 10 to 15 pads in one cycle while 29% shared that it depended on the bleeding and not number of
pads. Moreover, 23% shared that 6 to 10 pads were used during one cycle. The FGDs also showed 10
to 15 pads usage per cycle. The findings are detailed in Figure 19 below.
33%
29%
23%
14%
1%
5 to 7 6 to 10 10 to 15 depends on bleeding use cloth
Figure 19: No. of Pads Used during One Cycle
7.2. Frequency of Changing Pads
Working women and students shared issues in changing pads during working hours at the
school/colleges/ universities and offices. Working women (in government offices) from Faisalabad
shared that toilet cleaners are usually male and mostly only once a weak the basket is cleaned so it
feels bad to put the used pads in the office toilet bin, so they avoid changing while at work and prefer
to take the used pad/ napkin to their homes to dispose off properly. The respondents further shared
that men usually gossip about the issue and given the fewer number of females at workplaces they
often indulge in taking guesses who is going through their periods. Another group of medical students
from Faisalabad shared that they did not have clean toilets and changed pads when they went back to
home. A respondent from Multan shared that:
“Once I used a public toilet during my periods and got sever allergy. It
got so worse and I was hospitalised for one week.”

Similar issues were shared by the working women and students in different cities. Another woman
who was running a ladies‘ shop in Muzzafargurh shared that in the market there were no public
toilets for ladies and the long working market hours created issues. She further elaborated her
experience during periods as:
“During periods I go to one of my friend’s house (10 minute walking

distance) to change my pads when their males are not at home.”
The overall data shows that 55% women change their pads in 4 to 8 hours depending on their flow.
Whereas, 27 % change 3 to 5 hours, and 1% shared that they do it every 6 to 9 hours. These findings
are elaborated in Figure 20 below.
55%
27%
15%
1% 2%
3 to 5 hrs 4 to 8 hrs 5 to 6 hrs 6 to 9 hrs depends on bleeding
Figure 20: Frequency of Changing Pads
7.3. Monthly Cost
The data on the spending range showed the minimum value at less than 100 PKR while highest went
to 600 PKR and above during one month. In this, 57% consumers spent between 100 to 600 PKR.
Whereas, 24% reported more than 600 PKR for their one cycle, 3% shared that they have no
knowledge about price as their parents or elder sisters buy pads for them and 2% shared that one cycle
cost them less than one hundred either by using cheap products use of cotton by preparing pads at
home.
31%
23% 24%
14%
2% 3% 3%
Less than 100 100 to 300 150 to 500 300 to 600 above 600 No Cost no knowledge
Figure 21: Monthly Money Spent on Menstruation (Pads, etc.)

During discussion women shared that mostly three types of packs were in used (6, 12, 16). The family
pack was found to be cheaper and it was more appropriate when there were more than one
consumer(s) in one house. The price range was 200 to 600 PKR and in some cases 1500 to 2000 PKR
was also reported by a group of students in Quetta.54
7. Waste Management Practices

8.1. Disposal of Pads
Discussion with different groups revealed that religiously and culturally proper pads disposal was
practised and advised. The participants from the Hazara community in Quetta shared that they first
washed the pads and then threw them in the bin. Some respondents in Peshawar, Haripur and Multan
shared that they took out the cotton from the pads and then flushed it in the toilet after washing to
keep it sacred. Moreover, 80% of the women threw their pads by covering them in the same cover of
the pads and some used coloured plastic bags to keep it secret from outsiders. While 11% burned their
pads and another 4% buried their pads and 3 % respondents shared that they threw it in the open. A
small number 0.70% shared they washed, dried and burned the pads.
80%
11%
4% 3% 0.70%
Burn Bury Wrapped in bag Throw in Open Wash,Dry & Burn
Figure 22: Disposal of Pads
Pads disposal problems were reported in school/university toilets and hostels. A discussion with
hostel students in the Anthropology Department revealed:
“You cannot imagine how careless girls are these days. The pads are
throw on floor, sometime inside water tanks. The cleaner aunty has
many time arguments on this with girls but issues remain the same.”
In Muzzafargurh and Faisalabad, the burning of pads was the most common practice among women.
In Dadu, women throw their pads in open garbage land fill area/plot. Most women try to hide pads
while disposing of them because it was considered a private matter. Women in suburban areas wash
their cloth at night time when the men of the house are asleep so that no one sees them doing this. In
Peshawar, students complained that they face difficulty because there is no proper system for the
disposal of pads. Some fear that the sweepers/ cleaners might see their pads. Most of the girls in
Quetta said that they feel embarrassed when they have to pass in front of so many people or while
putting their pads in dustbins even at home. In some FGDs, respondents shared that they wash the
cloth and iron it to keep it for the next usage. In Dadu, women shared that they usually wash them at
night but due to small houses it is difficult for them to dry. In Quetta, women shared that due to
inflation they cannot afford to use new cloth every time and reuse the cloth. In Pashin, some women
reported that they dry pads in the sunlight to use them again.
54
Students in Quetta mentioned this price

8.2. Households Waste Disposal
The household waste practices revealed the highest number (50%) rely on private trash collectors.
Whereas, in different cities the municipal bins (33%) were also reported where trash is collected by
RDA (Rawalpindi Development Authority) in Rawalpindi, CDA (Capital Development Authority) in
Islamabad and WSSP (Water & Sanitation Services Peshawar), LDA in Lahore. Moreover, 17%
reported either about open or on land fill area mostly in Dadu while 0.80 % respondents shared
burning and burying practices.
50%
33%
13%
4%
0.40% 0.04%
Burn Burn & Bury Dumping site Bins Throw in open Trash Collectors
Figure 23: Household Waste Disposal Practices
8.3. Pads Material
In Lahore, all working women were aware of plastic being used in pads. In Quetta, a smaller number
of women were aware that pads contain plastic. Students in Islamabad were very much aware of this
that pads contain plastic which ultimately becomes part of the food chain. Women in Peshawar knew
that pads contain plastic. It was observed that household women were less aware of the composition
of pads. In Muzzafargurh , some women said that pads were made of silicone gel and cotton. The
quantitative data shows that 52% women have no knowledge whereas 26% think that pads are made
up of biodegradable materials (cotton, foam, paper, tissues, cellulose, fabric), while 22% consider that
plastic (plastic, polyester, polythene, recycling material and nylon, gel) is used as depicted in Figure
24.
52%
23% 22%
3%
Cotton Plastic Bio Material No Knowledge
Figure 24: Material(s) of Pads
In Karachi, women were aware that plastic takes time to decompose. In Quetta, the majority answered
that it takes 2-12 hours for plastic to degrade. In Pashin, a few stated that it would take 15-10 minutes
to dispose. In Muzzafargurh and Peshawar, almost all were aware that plastic takes years to degrade.

8.4. Knowledge on Biodegradable Pads
The assessment found that most of the consumers (at 92%) had no knowledge about biodegradable
pads and only 8% knew about it and they were mostly students.
92%
8%
Yes No
Figure 25: Knowledge on Biodegradable Pads
8.5. Willingness to buy Biodegradable Pads
In Lahore, some women shared that they would use biodegradable pads after proper testing. In
Multan, a group of women said that they would only buy biodegradable pads if they did not disturb
their budget. In Quetta, all the women except one were willing to buy expensive pads. In Islamabad,
most girls stated that people would feel reluctant at first to buy biodegradable pads, but they would
adopt it eventually with awareness and policy making. The quantitative data shows that 65%
respondent said if quality would be good and if biodegradable pads will be good for health and
environment then they will buy, whereas 18% said they will not buy it and similar percentage (i.e.
18%) said they were unable to predict without testing or knowing price and quality. Furthermore,
student expressed their desire that new pads should be infection free, lasting for long hours during
their university or office hours.
65%
18% 18%
Yes No Can not Predict
Figure 26: Willingness to Buy Biodegradable Pads
8. Beliefs around Menstruation

9.1. Restriction to Burn
The practices of reuse and burying and burning of pads were highlighted during discussions. In this,
25% respondents agreed that such practices exist, but 75% shared no such beliefs. This was
reconfirmed in the data as burning and bury practices were found in practice by women in disposal of
pads part.

59%
25%
16%
Yes No Do not Know
Figure 27: Practices of Reuse and Burning of Pads
9.2. Carrying Heavy Weight leads to Reproductive Health Issues
In all communities, lifting weights in general and during menstruation was not considered good. In
this, 65% shared that it creats problems in later stages while 17% reported no problems and 18% were
not aware about any such issues.
65%
17% 18%
Yes No Do not Know
Figure 28: Beliefs on Carrying Weight during Periods
9.3. Spicy Foods Restrictions
In many areas the spicy foods were shared not to be consumed during periods55. But young girls
shared that they consume the food as per their choice because some time they are not at home but they
were told by their mother to not have a cold, savoury and spicy food as it creates problems in
reproductive health. 10% of the respondents shared that they do not know any of such belief and 17%
shared that they do not believe that spicy food have any restriction. They consume it as per their
choice. A respondent shared that:
“I am not allowed to have dairy items in periods because my mother says

it is not good for health.”
55
Eating pickles yogurt, milk, or fruits in some areas were consider prohibited. There were also concerns related physical activities like running,
exercise performing etc.

74%
17%
10%
Yes No Do not Know
Figure 29: Beliefs around Food Restrictions
9.4. Open Discussion Prohibited
In this, 66% respondent shared that it was prohibited to discuss about menstruation even in front of
older women it was difficult to discuss genuine issues. While 29% respondents shared that it was not
prohibited, however, in front of men the discussion or issues could not be discussed due to privacy.
On this subject a female respondent from Jinnah College, Peshawar, shared that:
“It is not considered good talking about menstruation in our community

because girls are asked not to share with anyone that she is on her period.”
66%
29%
5%
Yes No Do not Know
Figure 30: Practices on Open Discussion around Menstruation
9.5. Restrictions on Performing Routine Activities
Mostly, the respondents at 68% shared that activities are not restricted. In Faisalabad, women
responded by saying that they were not allowed to make any milk-based food as milk is sacred to
them. Most of the young girls responded that their mothers stopped them from drinking cold water,
eating spicy food, and lifting heavy objects. The findings are summarised in Figure 31 below.

68%
21%
11%
Yes No Do not know
Figure 31: Restriction on Performing Household Activities
9.6. Menstruation Impurity
50%
45%
5%
Yes No Do not know
Figure 32: Beliefs around (Impurity
On the subject of restriction, it was noted that only religious activities were restricted and it was found
across all minority groups in Christians and Hindu women in Karachi and Peshawar, as well as the
Muslim respondents.
9.7. Bathing Prohibition
The most common response from all the provinces was that women were told not to bathe, lift heavy
objects, they were forbidden from cooking sacred meals56. In this, 62% shared that bathing created
problem and in first 3-4 days, bathing blocked the blood flow and created body swelling by disturbing
the overall cycle. Figure 33 captures the overall findings.
56
The meals used for giving’s, prayers, niaz and in some areas all the milk related products as milk itself was
reported sacred in some communities.

62%
23%
15%
Yes No Do not know
Figure 33: Beliefs Association with Bathing during Menstruation
9. Shopkeepers
In this assessment, a total of 182 shops were visited. Among them, 9% were women shops and 91%
were men shops. Among 182 surveyed shops, 78 shops were from Punjab, 17 from KPK, 55 from
Sindh and 32 from Balochistan. In every city, four different locations were selected in order to get
representative samples of cities. The tool was divided into following categories:
 Availability of Pads
 Cost of Pads
 Preferences/ Choices
 Types of Consumer
 Sanitary Management Awareness/Promotions
 Health and Environmental Concerns
182
165
17
9% 91% 100%
Ladies Shops Mens Shops Total Shops
Figure 34: Number of Shops
10.1. Availability of Pads
It was noted that pads were available on all shops. Overall, 23 brands were observed. The most
commonly utilised material was pads but cotton was also observed as a sale item by the shopkeepers.
The brands included Always, Butterfly, Trust, Mother Comfort, Mother Care, Molped, Cotex,
Cleopatra, My Lady, Lady Care, Daisy, Freedom, Ultrex, Camra, Density, Sincere, Comfrey, Just
Pad, Spot, Hygiene, Care, Neatex, and Fair Lady. Among these, Always, Butterfly, Cleopatra, Trust,
Molpad, Molfix, and Mother Comfort were present in majority in every city. The breakdown is
further elaborated in the Box below.

 Always 55% (Punjab 56%, KPK 65%, Sindh 64%, and Balochistan 31%) and
Butterfly 26% (Punjab 21%, KPK 18%, Sindh 27% and Balochistan 10%) are the
most popular and demanded brands in Pakistan and were present in every city
except in some shops in Quetta, Rawalpindi, and Muzaffargarh.
 Trust was found in 30 shops. It is abundant in Quetta, Dadu, and Islamabad.
 Molpad was found in 28 shops out of 142 shops surveyed in Islamabad,
Rawalpindi, Lahore, Multan, and Pashin.
 Cleopatra was available in 14 shops with its majority in Quetta, Pashin, Lahore,
Multan, and Haripur.
 Mother Comfort was available in 13 shops in Muzaffargarh, Haripur, Peshawar
and Quetta.
It was also noted that some products were found in specific cities as detailed in the Box below:
 My Lady brand which is an Iranian brand and Daisy are found in Quetta and
Pashin.
 Ultrex, Canbaby, Easybaby, Sincere, P&G and hygiene brands were found in
Rawalpindi.
 Fair lady brand was available in Faisalabad.
 Cotex and Camra brand is found in all shops in Lahore and Multan.
 Missrose, Neatex, Spot and Density in Muzaffargarh.
 Care brand was only found in some shops in Karachi.
68%
29%
12%
4% 5%
Always Butterfly Cleopatra Molpad Others
Figure 35: Available Brands (of Pads) in Shops57
10.2. Cost of Pads
The prices of different brands varied among different cities and also among shops of the same city.
Prices of all the sanitary pads started from 70 PKR for small packs to 980 PKR. Moreover, Always 8
pieces pack cost 300 PKR in Islamabad and Rawalpindi, but in Dadu 14 pieces pack was sold for 200
PKR. In Pashin, the price was noted for 250 PKR for 8 pieces pack and the same was noted in
Peshawar and Multan and prices were cheaper in Karachi. The 8 pieces pack of Always was 200 to
220 PKR while Butterfly 16 pieces pack also showed variation in prices. It was between 280-300
PKR in Lahore, Dadu, Multan and Faisalabad. But it was found more expensive in Islamabad,
57
In this figure, the total of percentages is not be hundred. All the total columns show that brand is available in that number
of shop (e.g. Always among total 182 shops it was available on 124 shops). At one shop more than one brands were
available. Others represent Trust, My Lady, Rahat, Onion, Cotext, Mother Care and Comfort, Daisy, Freedom, Sincere,
Molfix, P&G, Density, Neatex, Spot free, Cotext, Fair lady, Hygiene, Comfrey, Miss More, etc.

Rawalpindi on some malls, Quetta, Pashin i.e. 380-400 PKR. It can be seen that the standard packet of
sanitary pads which have 8 or 9 pieces ranges between 100 to 280 PKR irrespective of brands except
the ones which are not original products as those ones are comparatively a lot cheaper. In many cities
the product copies were available and shopkeepers were also aware about it.
10.3. Consumers Preferences/ Choices
The shopkeepers were asked about their choice of brands available in their shops. In this, 178
shopkeepers responded that they preferred the choice of brands in
their shops according to customer demand or those products which gave more sales. Moreover, only
4 shopkeepers were recorded in Sindh and Balochistan who preferred brands which were not very
expensive. According to regions, the availability of specific brands due to customer demand was high
in Punjab (100%), KPK (100%), Sindh (98%) and Balochistan (91%). It was highlighted that mostly
the customers have choices and if shopkeepers in major markets introduced something beyond the
expectations or choices, it will not be accepted by the consumers.
82%
2%
Customer Demand Demand on Price
Figure 36: Main Reasons for Selection of Product/ Brand (of Pads)
10.4. Types of Consumer
The assessment found that females are the primary buyers of sanitary products. In every city, the same
trend was noted. There were exceptions where household heads also bought these products. In rural
areas, such as Dadu, children were the prime buyers as females ask children to buy by writing name
and mostly children do not know what they are buying. According to the shopkeepers, the types of
buyers are different among these regions. Mostly females (59%) buy pads, followed by children
(16%) and this trend is high in Sindh and Punjab semi-urban areas and even in different highly
populous/urbanised areas. According to shopkeepers only 8% males do shopping for pads and this is
highest in Punjab and lowest in Sindh.
59%
25%
8% 9%
Men Women Both Kids
Figure 37: Types of Consumers (Mostly) Shopping Pads

10.4.1 Income Levels of Customers According to Shopkeepers
It was noted that respondents with varying socio-economic backgrounds, whether he or she belongs to
poor class or upper class, buy sanitary pads in addition to cotton these days. The shopkeepers shared
that mothers, if they do not use themselves then buy for their daughters, even sometimes without
telling their husbands. According to the observations of shopkeepers, different kinds of people do
shopping for pads and majority are mix (62%) that they cannot say exactly about their income level.
Moreover, 21% by middle class which is high in Punjab (31%) and Sindh (18%). It was highlighted
by the shopkeepers that some brands are cheap and people with limited income buy them for females.
In Quetta, women shared that Iranian brands are cheap and in case of shortage it become difficult for
them to buy other pads as they are out of their pocket. But they do it in emergency situations as it the
necessity for young girls and women.58
67%
21%
9%
3%
Mix Upper class Middle class Students
Figure 38: Economic Classification of Consumers
10.5. Sanitary Management Awareness/ Promotions
Most of the cities do not have any kind of awareness sessions from any NGO or company. Only 3%
shopkeepers reported these sessions. In Peshawar, shopkeepers shared that the distributers mostly visit
and sometime from these companies but those visits are mostly for branding and sales promotion not
for any kind of awareness. In Punjab (8%) and Sindh (9%) companies or NGOs conducted some
awareness sessions. In this, 92% responses showed that there is no awareness sessions about
menstrual products.
97%
3%
Yes No
Figure 39: Sessions by NGOs Reported by Shopkeepers
Furthermore, data findings show that some companies have promoted their products in certain
provinces which is 10% by Always (Punjab 13%, Sindh 13% and Balochistan 6%) and 7% by
Butterfly (Punjab 3%, Sindh 11% and Balochistan 9%). Some other companies such as Molped and
My lady (3%) also did awareness sessions in some regions such as Pashin. In KPK, all shopkeepers
said that there is no awareness sessions by companies. In Dadu, Agha Khan Foundation and HANDS
58
Response of women during shopping on the shop in Pashin.

were involved in creating awareness of sanitary products. It was also noted that most of the
shopkeepers promoted the products dependent on customer demand and their sales. The Box below
shares the details of the brands that the shopkeepers promote in respective cities:
 Butterfly brand in Pashin and Quetta.

 Molpad brand in Pashin
 Always brand in all cities, especially Quetta.
 My Lady is an Iranian product which is particularly promoted in Quetta.
80%
10% 7% 2% 1%
Always Butterfly Molpad My Lady No Sales

promotions
Figure 40: Brands Sales Promotion
10.6. Health and Environmental Concerns
The shopkeepers shared that if they get complaints about a certain brand, they replace the product
otherwise the consumers have multiple options in the markets. A female shopkeeper in Muzzafargurh
shared that they did not keep ‗Always‘ since the past five years as the distributers did not bring the
original product in their area. She further commented that she herself has gone through rashes and
allergies so did not prefer the brand. Similarly, the Molpad brand had also reportedly caused rashes
and allergies.59
10.6.1 Disposal Practices

It was noted that most of the shopkeepers (95%) had no idea about the disposal practices of sanitary
pads. In Muzzafargurh , some believed it was disposed by washing while 4% responses from Punjab
and Balochistan considered pads were put in covered dump and some shopkeepers in Multan held the
belief pads were buried underground.
95%
1% 4% 1%
Burried Covered waste dump Open throw No Knowledge
Figure 41: Shopkeepers' Knowledge about Pads Disposal
10.6.2 Waste Management in the Area
59
Reported in Rawalpindi only.

It was noted that 39% shopkeepers were unaware about the disposal practices of overall waste
management. The shopkeepers mentioned different waste management systems in different cities. In
big urban cities, municipal waste management systems were mentioned such as RDA (Rawalpindi
Management Authority) in Rawalpindi, CDA (Capital Development Authority) in Islamabad and
WSSP (Water & Sanitation Services Peshawar) in Peshawar and wastes in these regions were
managed by them. In Haripur and Dadu, open dumping was practiced as reported during the survey.
In other cities, such as Karachi, private waste collectors and municipal waste collectors managed the
waste of the area. Overall, 37% municipal bins were reported along with 22% trash collectors in all
cities. Buried and open dumping number was found to be limited. This was primarily due to the
situation that mostly the city markets were under city administration and the reported municipal bins
were not the same for the overall city and different areas. As in Rawalpindi, the Cantonment Areas
have this privilege although not the whole city so the areas manage their waste either by throwing in
open dump or give it to waste collectors.
39%
37%
22%
1% 1%
Burried Bins Throw Away Trash collectors No knowledge
Figure 42: Knowledge about Community Waste Disposal Practices
10.6.3 Decomposition Time and Health/ Environment Side-effect:

Most of the shopkeepers (85%) are not aware of the decomposition duration of sanitary pads and this
number was particularly high in Sindh (100%), KPK (85%), Punjab (79%) and Balochistan (75%).
The decomposing duration of plastic and material of pads was mentioned in hours and months. In this,
only 1 % shared that it takes ‗a lot of time‘ or ‗never decompose‘. Some were also concerned about
the health of animals as they themselves have seen or practiced (watching animals to swallow the
shopping pages). One shopkeeper in Muzzafargurh shared that their neighbour‘s cattle became sick
after swallowing the sanitary pad that was thrown openly.
The responses were also very different about the decomposition duration of pads as some mentioned
hours (4%), days (4%), months (3%) and years (2%). In Haripur, some respondents shared it took 100
of years to decompose while some in Islamabad stated that it took 2 to 5 months to decompose. Some
answers were also about few days. But most of them had no idea about decomposition and side effects
of pads. Shopkeepers from Karachi in particular had no idea about the subject.

85%
4% 3% 3% 2% 1% 2%
Hours Days Months Years Never Risks for No knowledge

Decompose Animal
Figure 43: Knowledge about Decomposition of Pads
10.6.4 Material of Sanitary Pads

Most of the shopkeepers (76%) have no awareness about the material of the sanitary pads especially
in Sindh and KPK where all shopkeepers were unaware. Shopkeepers in Quetta, Islamabad, Multan,
and Muzzafargurh cities were relatively aware. It can be contended that in these cities, the LHWs at
household level and NGOs were also reported to have conducted sessions. The responses included
cotton, plastic, polyester, chemical and some shared that it was made up with mixed materials.
76%
10%
4% 6%
3%
Cotton Plastic Chemicals Mix No Knowledge
Figure 44: Knowledge about Composition Material(s) Used in Pads
10.6.5 Biodegradable Pads

The assessment found that most of the shopkeepers had not heard about biodegradable pads except
2% (6) shopkeepers in Rawalpindi, Quetta, Muzzafargurh , Lahore and Islamabad.

98%
2%
Yes No
Figure 45: Knowledge about Biodegradable Pads
Nonetheless, all of the respondents said that they would introduce the product if it will be available in
market and if ‗consumers demand it‘. The dependency of shopkeepers and their products is on
consumers and if the consumers prefer the product(s) then the product could be successful. Some very
good suggestions were also provided by shopkeepers in Muzzafargurh , Multan, Islamabad, and
Peshawar. They suggested to engage the education and health departments through schools, colleges,
universities, and hospitals in general and specially the gynaecology wards. The also suggested that
television and social media platforms can bring change, but first the consumer must understand the
composition of existing products and its related harmful effects on health and environment.
56%
14% 14%
7% 9%
Quality Price Price&Demand Difficult to Sell Yes
Figure 46: Willingness to Sell Biodegradable Pads
10. Household Heads

In the four provinces (12 cities), 135 men were interviewed to assess their knowledge on women‘s
health, MHM material used by women, disposal practices and knowledge about biodegradable pads
11.1. Shopping Trend(s)
The overall household groceries‘ shopping was mostly conducted by men in most of the cities. In this,
59% males responded that they shop their groceries whereas 24% shared that their women mostly do
the grocery. In this, 23% women shared they did the monthly shopping while 18% shared that they go
for groceries together as depicted in Figure 47 below.

59%
23%
18%
Male Female Both
Figure 47: Shopping Lead
The heads of households were also asked about the grocery lists. In this, 53% shared that the list is
mostly prepared by women and they only have to shop as per the provided list. Whereas, 26% shared
that they themselves prepare the grocery list and 21% shared that they both make it. The women
making the grocery list was highest in Punjab (62%) and lowest in Balochistan (43%).
53%
26%
21%
Male Female Both
Figure 48: Grocery List
Menstrual products are an important part of the grocery list and 60% of males responded that it was
mostly included whether they buy it or the women go for shopping themselves. Moreover, 43%
responded that it was not included in the list and the women would know it better and 8% had no
knowledge about it.
49%
43%
8%
Yes No No knowledge
Figure 49: Pads in Grocery Lists
11.2. Knowledge on Menstrual Products Used at Home
Many men were aware of the brands and types of pads used by females in their homes. According to
the responses from the heads of households in different cities, the brand ‗Always‘ (48%) is the highest
used brand in all areas and particularly in urban areas. The trend was followed by other types and
brands such as Butterfly (16%), Molped, Trust, My Lady, Rahat, Dove, Cleopatra, and Perfect

collectively at 15%. Some males also said that their wives use Cloth (4%) which was reported by men
from Pashin and Lahore. The findings are detailed in Figure 50 below.
48%
24%
12% 11%
4%
Always Butterfly Others Cloth No Knowledge
Figure 50: Knowledge about Sanitary Pads Used at Home
11.3. Monthly Spending on Pads
The average amount spent on pads by household was reported from 150 to 2000 PKR in some areas
based on the family sizes. In this, 37% respondents shared 250-500 PKR as the month expenditure.
However, 150-250 PKR was spent in many areas in Sindh (50%) and KPK (33%). In Punjab (2%)
males spend 1000-2000 PKR which means small numbers have the willingness and capacity to buy
expensive and good quality products and their financial situation makes them capable to more focus
on the health issues of women particularly during menstruation. A huge number of household with
male heads (30%) did not know about monthly spending because in many areas males give the budget
to the females of the family for the overall monthly expenses and then females spend the money as
per the needs of the household.
30%
27%
16%
14%
11%
1%
100 to 250 250 to 500 500 to 1000 1000 to 1500 1500 to 2000 No knowldege
Figure 51: Amount Spent on Sanitary Pads
11.4. Willingness of Males for Buying Pads
A total of 47% respondent showed interest to buy pads without any hesitation and stated that they
consider it as their responsibility. This willingness varied among provinces such as Punjab (65%),
Balochistan (34%) and KPK (29%). Moreover, males in Islamabad (89.55%), Haripur (75%),
Rawalpindi (60%), Multan (60%), and Pashin (30%) preferred to buy pads for the females of their
households. Whereas, 33% males were not interested and this number was highest in Sindh (90%),
followed by KPK (67%). Overall, 20% men avoided to answer this question as shown in Figure 51.

47%
33%
20%
Like to buy Feel uncomfortable avoided to answer
Figure 52: Men's Perception about Shopping for Sanitary Pads
11.5. Disposal Practice
The assessment shows that males have different opinions about disposing the pads safely. Their
responses showed that they thought it was very embarrassing to see pads everywhere outside in our
society and held the belief that pads produce bad smells and block sewerage pipelines. In this, 15%
shared that pads were disposed by burning which was reported highest in Sindh (90%), followed by
the option of burying (7%) which was highest in Balochistan (14%), and placed in the dustbin (31%)
again highest in Balochistan (43%) followed by Punjab (25%) and KPK (19%). Some also believed
that pads were disposed by handing over to the waste collectors (1%) and by open dumping (18%)
and this was reported highest in KPK (29%) and Balochistan (26%). Overall, 39% of males did not
know about disposal practices as shown in Figure 53.
39%
27%
16%
13%
6%
1%
Burn Bury Bins Waste collectors Open Dumping No knowledge
Figure 53: Disposal Practices
11.5.1 Environmental Pollution due to Pads

Within the disposal practices, the majority of male respondents (85%) in these cities agreed that open
dumping of pads caused environmental pollution and spread diseases. In this, 100% responses
revealed this belief in KPK, Sindh and Balochistan. They thought it looked awful in the streets and
caused diseases and attracted pests resulting in food contamination. The respondents also named
different diseases (Hepatitis, Typhoid, Flu and Malaria) linked to the improper disposal of pads. They
further included that pads blocked sewerage pipes. Overall, 14% of male did not know whether pads
were causing environmental pollution as shown in Figure 54.

85%
14%
1%
Yes No No knowledge
Figure 54: Stats of Knowledge on Impact of Pads' Disposal on Environment
11.6 Knowledge on Production Materials of Pads
The heads of household provided different views on the composition of pads. For instance, cotton
(21%), plastic (16%), polyester (5%) and chemicals (4%) were also part of the responses. However,
some also responded about the combination of cotton, polyester, and plastic collectively. Whereas,
some of them also thought that it was made of cloths (6%). Overall, 50% of male respondents did not
know about the combination of pads. This number was high in Sindh (80%), KPK (67%), Punjab
(52%) and Balochistan (26%) respectively where the males did not know about the production
materials of pads.
50%
21%
16%
5% 4% 4%
Cotton Polyester Plastic Chemical Cloth No Knowledge
Figure 55: Knowledge on the Material Composition of Pads
11.7 Willingness to Buy Environmental-friendly Pads
Mostly heads showed willingness to buy environmental friendly pads that did not pollute the
environment and were safe for health. But there was only one concern that without knowing the
quality and price of the product, the respondents could not fully agree. They shared that though such
brands should be introduced but it was only the women who should decide the willingness to use.
68%
20%
12%
Yes No Cantot predict currently
Figure 56: Willingness to Buy Biodegradable Pads

11. Manufacturers
Discussion with Syntax and Anion were also conducted about biodegradable pads. During the
discussions, manufacturers shared that the awareness about biodegradable pads is very limited among
the masses. If a new product is launched, the prices will not be low. It is only possible if the new
launched product is introduced with heavy budget and through support from China (engaging Chinese
companies as labour and expertise would be required on a large scale). However, they shared that in
the current scenario, imports were banned in Pakistan. The shopkeepers that owned small enterprises
held concerns that it would be difficult for them to take chances over introducing such a product as
consumers/ buyers may not buy the biodegradable pads and that would lead to loss. The
manufacturers had observed that the shopkeepers would be willing to sell the product if they had
assurances that the buyers/ consumers would buy the new product based on the demand creation by
the manufacturer(s). It was also noted by the manufacturers that the shopkeepers had ‗no knowledge‘
about biodegradable pads in general or the shelf life of biodegradable pads, and these concerns further
dissuaded the shopkeeper to buy these pads from the manufacturer. They also shared that the price(s)
would likely be high due to the materials involved and it will not be easy for shopkeepers to buy
expensive products on risk as consumers were more concerned about cost and absorption.
The manufacturers also raised the concerns that the biodegradable pads might have less absorption
capacity, thus, there was less chance that the consumers would be willing to buy the product. Most of
the consumers, especially young girls, preferred thin pads with good absorption therefore the
manufacturers needed to produce thin biodegradable pads with good absorption. It was also discussed
that in the current scenario, the shopkeepers and the consumers were not aware that the biodegradable
pads were environment-friendly. It was also noted in the discussion(s) that while the expertise and
materials were available yet some materials needed to be imported that would further increase the
production cost. It was particularly shared by Syntax that the production size i.e. the size of the
product needed to be huge so that the profit margin is not on stake. Furthermore, while the
biodegradable pads were not as absorbent, they also needed to be changed every 6 hours; thus, the
consumption of the pads will be high which increases the expense for the consumers (i.e. the
girls/women). The manufacturers emphasized that unless the people are not educated about
biodegradable pads, they will not succeed in the market. For this, advocacy at the government level is
required to up-lift tax on sanitary napkins particularly on biodegradable pads.
12. Recommendations
Based on the study finding, the assessment makes the following recommendations:
 Considerations about cost-effectiveness of the product: While introducing biodegradable pads, it

should be considered that more consumption of the pads means that girls/ women need to
purchase more pads and if the cost of the product is high then it will be a huge burden on the
consumer; therefore, it is important that manufacture take care of the cost-effectiveness of the
product.
 Selection of the audience/community: While introducing biodegradable pads, the selection of the
audience/community is essential. This is important because the purchase of pads from towns is
more common than purchasing the same from union council-based retail shops – unless the shop
is owned and managed by a woman. A common source of purchase of menstrual material is from
female vendors who engage in door-to-door selling of sanitary pads, underwear, and cotton.
Girls/women still face challenges in accessing menstrual products at school, healthcare centres,
and market areas/places.

 Focus on the absorption capacity of biodegradable pads/ product: Girls are concerned about the
absorption capacity of the pads, the recent market study and mapping of the existing supply chain
indicated that around 79% girls are not satisfied about the absorption capacity of the commercial
pads; therefore, the manufacture of biodegradable pads should seriously consider this aspect.
 Use of information, education and communication: Before introducing biodegradable, there is a
need to create demand by using different IEC/BCC material, especially focusing on the
environmental-friendly aspect of biodegradable pads. This should be coupled with engagement
and use of media, schools, universities and colleges as well as hospitals and lady health workers
to promote the new products, if introduced.
 Sustainable supply chains and mechanism: The high consumed menstrual products are supplied
at retailer doorstep by suppliers and wholesalers, whereas the average or less consumed menstrual
products retailers buy by themselves. This is because the demand for these products in their areas
is low, and suppliers do not deliver small size orders as it incurs high delivery costs. This point
also needs to be considered while introducing biodegradable pads.
 Demand creates supply: Almost 75% of respondents were willing to spend from 150 to 300 PKR
per menstrual cycle. There seems to be a growing awareness among women and girls regarding
the importance of using hygienic materials for managing their menstrual cycle. Before introducing
biodegradable pads, demand creation is required, which covers all aspects such as absorption,
comfort, and environment-friendly nature of the product.

13. Annexures
Annex I: Data Collection Tools
Girls/Women Questionnaire
 Consent: Please ask for the willingness before filling the questionnaire and share the objective of collecting
the information. How and where this information will be used. Then precede the interview once they agree.
 Objective of study: The present data is collected a part of assessment of menstruation hygiene and
management practices and available sanitary products in the market. The findings will be utilized to provide
more viable environmental and healthy solutions to consumers of sanitary pads.
 Instruction: circle the responses or write the appropriate answer in the space provided.
City Name:---------------------
Demographic Information
Respondent age
1.
2. Education
3. City
a) Student
Your Job/Status
4. b) Working Women
c) Household Women
Institute Name: (Institute or University)
5. (For students and working women)
a) Married
6. Marital status b) 2. Un-married
a) 1.Illiterate
b) 2.Primary
c) 3.Middle
7. Father education d) 4.Secondary
e) 5.Bachelor
f) 6.Masters
g) 7.Above Masters----
a) Illiterate
b) Primary
c) Middle
8. Mother education d) Secondary
e) Bachelor
f) Masters
g) Above Masters----
9. Father/Guardian Occupation
10. Mother/female guardian occupation
Menstrual Knowledge
a) Yes
Does your family have a TV or/and
11. radio or any other medium? b) N
c) o
a) TV
b) Radio
From whom did you heard about disposable c) LHVs
12. sanitary napkin d) Community health workers
e) Friends
f) Others:-----------------------
13. At what age your periods started
Did anyone tell you about period before you a) Yes
14. started menstruating? b) No
If yes, from who did you first learn about a) Mother
15. periods? b) Teacher
(You can select more than one options) c) Friends

d) Media (-------------)
e) Relatives (Aunt, grandmother, sister etc.)
f) Others (Specify)
Do you do any preparation before your a. Yes
16. period? b. No
At what age, do you think most girls usually a. Years

17. get their first period? b. Don‘t know
How many days should a girl‘s menstrual a. Days

18. bleeding last? b. Don‘t know
a. Days
19. What is the length of the menstrual cycle? b. Don‘t know
20.
Menstrual hygiene management materials
a. Reusable cloth pad
b. Disposable sanitary pad
What absorbent materials do you
c. New Piece of Cloth
21. frequently use during menstruation?
(More than one answer is possible) d. Cotton wool
e. Other (specify)
a. Comfort
b. Safety
c. Cost
d. Availability
22.
What influences your choice of menstrual e. Ease of disposal
absorbent materials? f. Ease of re-use
g. Other (specify)
a. Always
b. Butterfly
c. Molped
d. Kotex
23. Any specific brand of your choice?
e. Tampax
f. Onion
g. Other (specify)
a. Better absorption capacity

b. No worry of leakage
c. Save your valuable clothes from blood stains
d. Prevent infection
e. Comfort
24. Any reason for choosing a specific brand
f. Good fragrance
g. Best for traveling
h. Best for taking part of any games/ attending any event
i. Other (specify)
a. Head of family
b. Mother
25. Who purchase sanitary napkins for you? c. Yourself
d. Other (specify)_________
a. Yes
Are sanitary pads on shops in your area b. No
26. available? c. Don‘t know
27. Have you bought disposable sanitary a. Yes

napkins from a shop in the last two b. No
months?
a. I still have some pads
b. I don‘t have money
c. My parents buy for me
28. If no, why have you not bought? d. It is not yet time to buy for next period
e. I am embarrassed to purchase pads
f. Others:--------------
Casting
29. How many pads do you use during a cycle?
How much do you or your household spend
30. on disposable pads in a month?
Disposal Practices
a) Dustbin
b) Buried
Where do you dispose of your sanitary c) Burnt
31. napkin at house?
d) Open area
g. Others:-----------
a) Municipal bin
Where do you dispose of your domestic b) Waste collector
32. waste?? c) Open area
h. Others:--------------
Health
What kinds of foods you preferred during
33. periods?
What kind of problems is faced during
34. menstruation?
a. Depression
b. Mental distress
c. Body aches
Do you experience any physical or
d. Pain in the breast
35. emotional symptoms during your period?
e. Fatigue
f. Nothing
g. Other
36. How do you handle any symptoms if faced?

What material do you think the pads are
37. made of?
Have you ever heard about biodegradable
38. pads?
Cultural and Religious Beliefs60 Yes No don’t know
It is prohibited to openly discuss menstruation and its management in my
39. Family/community
Menstruating girls are prohibited from performing house chores such as
40. cooking, fetching water, sweeping etc.
41. Menstruating girls are considered unclean and impure
Taking bathe during menstrual period can result in decrease in menstrual blood,
42. swelling in the body and complications after marriage.
Spicy and cold foods should not be eaten during the menstrual periods to avoid
43. stoppage of menstrual blood and ill health
44. The cloth or pad used during menstruation should never be burnt but instead be
60
Are there any restrictions related to culture, religion for performing any activity or related to food
consumptions.

washed and reused.
The cloth or pad used during menstruation should never be burnt but instead be
45. washed and reused.
If a girl carries heavy things during her menstruation, her period will stop
46. immediately or will become irregular.
Focal Group Discussion (FGDs)
 Group Consent: Before initiating the discussion, discuss the objectives and get consent of each participant.
Read the consent form and get it signed with the group participants. Clearly read all the step as given in
FGD protocols and then proceed for the discussion.
 Specific Objective: Defining cultural understanding and meaning of menstruation, decoding social
constructions about periods and its related stigma, menstrual hygiene management practices, preferences for
using particular product/material and its impact on health and environment.
I. Menstrual Hygiene Knowledge

1. What you call periods in your language, or how do you call it when you talk with your friends? 61
2. What do you know about periods/menstruation, your knowledge on periods e.g. (normal phenomenon for
reproductive health), or anything else?
3. Have you ever got information, guidance or awareness on hygiene for managing your periods; if yes from
whom and how?
4. Who first told you about periods and what was your age at that time?
5. Who do you feel most comfortable to talk with about your menstrual hygiene?
II. Menstrual hygiene practices and WASH facilities

1. For managing your monthly periods, do you make any preparation before time? If yes please describe?
2. What difficulty do you face during your periods; during your daily routines inside the house or when you go
outside during periods?
3. What you use for managing your periods (type of napkin, e.g. cloth, material, pads)?
4. From where do you buy it? Local shop or super market, or make it at home or any other?
5. Do you buy pads for yourself or anyone else buy for you?
6. How many pads do you use during one cycle?
7. How many pads one pack have if you use any specific brand?
8. How much price do you pay for the pads?
9. What is the reason of choosing it?
10. After how many hours/time you change your pads?
11. Sanitation pads/material you are currently using, do you face any problems e.g. (itching or any other
problem?
12. How and where do you dispose of your used pads?
13. Do you face any problems in disposing of used pads?
14. If you use the cloth, how do you wash it? Where do you dry it, is it in shade or sun light during day time or
during night. How do you save it for next use?
15. Where the pads washed water goes?
16. Do you face any problem regarding this?
III. Preferences of Usage

17. What type of material you prefer to buy. What are quality, preferences for any particular product you buy
and use?
18. Do you use any preferred brand? If so, what properties does it have (e.g. fragrance, durability, absorbency,
size, comfort, infection prevention), etc.
16. Do you understand the pictures or language on the label?
17. Are you facing any problems while using your preferred brand?
19. Have you ever switched to a different brand of sanitary pads that you used before? If yes, please share the
reason?
61
This question will set the tone and will provide researcher to initiate the discussion

IV. Social/Cultural Aspects
19. What are the beliefs with periods in your culture/community? How do they affect you?
20. Is there anything that you are restricted from or can‘t do during your period?
21. What do men (and boys) know and think about periods in your area?
V. Health & Nutrition

24. Do you experience any physical or emotional symptoms before your period starts?
25. Before your period, do you experience any bloating and abdominal cramps, gastrointestinal problems (such
as decreased appetite), abdominal swelling, swelling of the hands/arms and legs, headaches, irritability and
mood swings or any other type of problem? Please share?
26. Do you experience any pain in the joints, muscles, back and breast tenderness before menstruation?
27. Do you feel anxious, depressed and tired before your period?
28. Do you experience any pain during your period? If so, how do you handle it? Is it a home treatment or do
you visit a doctor.
29. Have you ever felt embarrassed during your period? If so, please share the reasons?
30. How would you describe your diet?
31. What do you think a healthy diet looks like?
32. Do you think calcium and low milk fat are important in the diet?
33. Do you take milk and milk products during menstruation? If not why
VI. Environmental
22. Do you know that most of commercially available sanitary pad contain plastic?
23. Do you know how much time plastic takes to dispose of?
24. Have you ever heard about biodegradable pads?
25. If yes, what material is used for it? and how it can be environment friendly
26. If new bio degradable pads are introduced in the market, what qualities you suggest it should have?
27. If it has a little more cost as compared to your current pads will you be willing to buy it?

Questionnaire for Service providers (Shop Keepers)
 Consent for participation in Interview: Please introduce yourself and objective of the interview. Respond
to their questions if they have before initiating the interview. Ask for the respondent permission and if they
agree, proceed for the interview.
 Objective of Interview: The present interview is a part of assessment of menstruation hygiene and
management and available sanitary products in the market.
Shopkeeper Name :--------------------( Optional)

City: ----------------------------------------
Area: ---------------------------------------
Market Name: ---------------------------
Store Name: ------------------------------
Phone Number:--------------------------
Key Questions
I. Availability of Pads
1. Do you have sanitary pads at your shop?
2. If yes what are their types and brands?
3. In one pack, how many pieces does it have?
II. Cost of Pads

4. What are the prices of different brands available at your shop?
5. What is the lowest range and highest range of prices?
III. Preferences/ Choices

6. Why do have only these brands available and not others at your shop?
7. Which brand is mostly preferred by the consumer based on your sales?
IV. Types of Consumer

8. What type of consumer mostly does shopping of sanitary pads? (women/girls or any other)
9. What is the income level based on your observation when they shop?
V. Sanitary Management Awareness/Promotions

10. Does sanitary companies or any one e.g. NGOs ever visited the area and have sessions with service
providers or community; If yes, can you share the details?
11. Do you ever have sales promotion for promoting the sanitary products? If yes which company?
VI. Health and Environmental Concerns

12. Have you ever got complaints from the consumers for any health issues after using any particular
product; if yes can you please share the detail?
13. Do you know about the disposal practices of sanitary pads? If yes what are these practices?
14. How is waste collected, managed in the area (waste management system in your area)
15. Do you know what material sanitary pads have e.g. (plastic and chemicals).
16. How much time does the sanitary napkins take in decomposing e.g. in soil and create any problems for
human and animal health?
17. Have you ever heard about biodegradable pads? If these are introduced in the market, will you
sell them on your shop?

Questionnaire for Head of Household (Males)
management awareness among head of household (males).
Name :--------------------( Optional)

City: ----------------------------------------
Area: ---------------------------------------
Phone Number: --------------------------
Key Questions
I. Shopping Trend
1. Who does shopping at your home?
2. Who make grocery list at your home?
3. Does the grocery list include sanitary pads?
II. Knowledge on Menstrual Products Used at Home

4. Which kind of pads do women in your house use which you are buying?
5. Do women in your home use a special brand of pads? Please tell
III. Monthly spending on Pads

6. How much do you spend on pads during one month?
IV. Willingness of Males for Buying Pads

7. Do you like to buy pads for women at your home or you feel uncomfortable?
V. Disposal Practice
8. According to you how to dispose pads?
9. Do you think disposing pads in open area cause environmental pollution? Please describe
VI. Knowledge on Production Materials of Pads

10. Do you know what pads are made of?
VII. Willingness to buy environmental friendly pads

11. If environmental friendly pads are introduced in the market which are also healthy for women but it‘s
little expensive will you buy?
VIII. Other questions
12. Are you worried about spending money? Or do you think it's necessary, clean and important for women
health?
13. Do you buy sanitary pads due to its price or do you like it?

Questionnaire for Manufacturers
management and available sanitary products in the market.
Name of the Manufacture: --------------------------------

Key focal person interviewed:-----------------------------
City:--------------------------------------------------------------
Interviewee Name:-------------------------------------------
Phone:-----------------------------------------------------------
Key Questions:
1. What type of sanitary products do you produce?
2. Where is it sold in terms of scale( e.g. all over Pakistan)
3. What type of material is used? Is it locally available or imported?
4. How much does it costs? By each product type?
5. What are their names?
6. What are market trends in this product line? Have you undertaken any study?
7. Are there any biodegradable Pads? If not what would be important to consider to produce bio degradable
pads?

Annex II: Lists of Cities and Institutions Consulted for Data Collection
List of Cities
Table 1: List of Cities
No. Provinces Cities
1. Rawalpindi
2. Lahore
3. Muzzafargurh
Punjab
4. Multan
5. Faisalabad
6. Islamabad
7. Peshawar
KPK
8. Haripur
9. Karachi
Sindh
10. Dadu
11. Quetta
Balochistan
12. Pashin
Lists of Institutions
No. Name of Institution
Universities
1. Punjab University
2. Superior University
3. University of Management and Technology, Lahore
4. Islamia University of Bahawalpur
5. University of Lahore
6. Lahore College for Women University
7. Bahawadin Zakria University
8. Quaid-i-Azam University Islamabad
9. International Islamic University
10. Allama Iqbal Open University
11. Bahria University, islamabad
12. National University of Sciences & Technology (NUST)
13. National University Of Modern Languages
14. COMSATS University Islamabad
15. Ripah University
16. Pir Mehr Ali Shah Arid Agriculture University Rawalpindi
17. Capital University of Science and Technology
18. Rawalpindi Medical University
19. Fatima Jinnah Women University Islamabad
20. Shifa Tameer-e-Millat University
21. Institute of Space Technology (IST)
22. Pakistan Institute of Engineering & Applied Sciences (PIEAS)
23. Shaheed Zulfikar Ali Bhutto Institute of Science and Technology
24. University of Sargodha
25. University of Central Punjab
26. Government College Women University Sialkot
27. University of Agriculture Faisalabad
28. Government College University Faisalabad
29. University of Okara
30. KFUEIT - Khwaja Fareed University of Engineering and Information Technology.
31. University of Education

32. University of Veterinary & Animal Sciences - UVAS Lahore
33. University Medical and Dental College Faisalabad
34. Government College University Lahore (GCUL)
35. Mirpur University of Science and Technology (MUST)
36. University of Haripur
37. University of Peshawar
38. Islamia University
39. Khyber Medical University
40. CECOS University of IT and Emerging Sciences
41. University of Wah
42. Shaheed Behazir Bhutto Women University
43. University of Sindh Jamshoro (Dadu Campus)
44. Sardar Bahadur Khan Women's University
45. University of Balochistan
46. Alhamd Islamic University
47. Shifa Tameer-e-Millat University (STMU)
48. Comwave Institute Of Science & Informatoin Technology62
49. Margala Institute of Health Sciences
Colleges
50. Aspire college
51. Amy Medical College Rawalpindi
52. City College
53. Government Degree College Rawalpindi
54. Excel College
55. Bilquis Education College For Women
56. Fauji Foundation College
57. Islamabad Model College for Girls Rawat
58. Kinnaird College for Women
59. KIPS College
60. Punjab Group of Colleges
61. Sialkot College of Physical Therapy
62. Sadiq Egerton college
63. Government Degree College Peshawar
64. Peshawar Medical College
65. Government College Dadu Sindh
66. Government Girls College Quetta
67. Government Degree College Quetta Satellite Town
68. Government Girls Degree College Sardar Hassan Musa Qta
69. Islamia Girl College Quetta
70. Girls College Quetta Cantt
71. FG College Cantt Quetta
72. Government Girls College Jinnah Town Quetta
73. Sandeman collage
74. Rise Institute of Accounting
75. Nisa College
76. Fazaia Medical College (FMC)
Schools
77. Leaders School System
78. Bright School of Sciences
79. Government College High School Lahore
80. The Educator School
81. Government Iqbal School
62
Sarhad University of Sciences and Information Technology (SUIT)

82. Government School Johi District Dadu
83. Star Pubic School
84. Government Girls High School Kassi Road
85. Rahim Public School
86. Nizami Islamic High School
87. Bright Way School Pashin
88. Beacon House
89. Iqra School
90. New Crescent High School Quetta
91. Alhamad Public School Quetta
92. Grand Folks School Quetta
93. Bright Kids School
94. Grammar School
95. Olives School
96. Shan Children Academy
97. Times Schooling System
98. Sundimam school
99. Pakistan School Salalah
100. The Cambridge Kids School
NGOs / Private
101. World Wide Fund (WWF)
102. UN & UNDP
103. UNICEF
104. Water, Environment and Sanitation Society (WESS)
105. Institute of Regional Studies Islamabad
106. CHIP Training & Consulting
107. Pelican Development Organization
108. Attia Welfare Society
109. Peace & Development Organization (PDO)
110. Nayatel
111. Nari Development Organization (NDO)
112. Dawlance
113. Small and Medium Enterprises Development Authority (SMEDA)
114. HANDS
115. DANESH
116. International Rescue Committee (IRC) Pakistan
117. Medical Emergency Resilience Foundation (MERF)
118. Participatory Integrated Development Society (PIDS)
119. Expert Women Empowerment Training Center Quetta
120. Rahnuma-FPAP- Family Planning Association of Pakistan
121. Taraqee Foundation
122. Khan and Company
Government Departments/Offices
123. EPA Punjab
124. Education Department Punjab
125. Social Welfare Department Quetta
126. Nutrition Department Quetta
Hospitals
127. Shifa Hospital
128. Civil Hospital Quetta
Others
129. Libra Beauty Parlor Peshawar
130. Apex Maria Saloon (Beauty Parlor) Peshawar

nnex III: Analysis Tables
Demographics
Table 1: Respondents from each province

District Respondents
Punjab 39%
KPK 24%
Sindh 21%
Baluchistan 17%
Total 100%
Table 2: Occupation of Respondent

District Household Women Student Working Women Total
Punjab 24% 55% 21% 1079
KPK 35% 58% 8% 649
Sindh 21% 68% 11% 565
Baluchistan 41% 37% 23% 458
Total 29% 55% 16% 2751
Table 3: Marital Status of the Respondents from each province

District Single Married Divorced Widow Total
Punjab 72% 28% 0.5% 0% 1079
KPK 63% 37% 0.0% 0% 649
Sindh 79% 20% 0.0% 0% 565
Baluchistan 66% 34% 0.0% 1% 458
Total 70% 29% 0.2% 0% 2751
Table 4: Education Status of Father

District Illiterate Primary Middle Secondary Matric B.A Masters+ Total
Punjab 10% 9% 14% 24% 4% 18% 20% 1079
KPK 16% 4% 7% 25% 0% 21% 27% 649
Sindh 35% 14% 14% 18% 1% 8% 10% 565
Baluchistan 30% 10% 15% 15% 0% 15% 15% 458
Total 20% 9% 13% 21% 2% 16% 19% 2751
Table 5: Education status of Mother/Guardian

District Illiterate Primary Middle Secondary Matric B.A Masters+ Total
Punjab 23% 18% 14% 18% 1% 13% 12% 1079
KPK 28% 16% 16% 20% 0% 13% 6% 649
Sindh 45% 13% 12% 17% 0% 7% 6% 565
Baluchistan 52% 10% 13% 10% 0% 9% 6% 458
Total 34% 15% 14% 17% 1% 11% 8% 2751
Table 6: Fathers/Husband Occupation

District Farming Govt Employee Business Private job Jobless Driver Labor Others Total
Punjab 4% 25% 24% 17% 1% 4% 15% 10% 1079
KPK 1% 26% 34% 19% 3% 5% 2% 9% 649
Sindh 5% 16% 17% 19% 2% 5% 32% 4% 565
Baluchistan 3% 24% 23% 17% 5% 3% 18% 6% 458
Total 3% 23% 25% 18% 3% 4% 16% 8% 2751

Table 7: Female/Mother house head Occupations
District Govt Employee Housewife Private Job Jobless Others Labor Business Total
Punjab 5% 84% 7% 2% 1% 0.4% 8 1079
KPK 6% 81% 6% 0% 5% 0.0% 5 649
Sindh 5% 84% 2% 2% 2% 4% 1 565
Baluchistan 3% 83% 7% 3% 3% 0% 1 458
Total 5% 83% 6% 2% 3% 1% 15 2751
Table 7: Pre Menstrual Information

District Yes No Total
Punjab 65% 35% 1079
KPK 71% 29% 649
Sindh 76% 24% 565
Baluchistan 82% 18% 458
Total 72% 28% 2751
Table 8: Access to type of source of information

District Mobile and internet Radio and newspaper TV Total
Punjab 4% 0% 95% 1079
KPK 0% 0% 99% 649
Sindh 10% 1% 89% 565
Total 4% 1% 95% 2751
Menstrual Hygiene Knowledge Questionnaire (percentages)
Table 9: % of Source of Pre-Menstrual knowledge

Family Social
District Friends LHWs School/NGOs Total
Member media/TV
Punjab 79% 12% 0% 1% 8% 707
KPK 54% 30% 0% 9% 6% 461
Sindh 74% 19% 1% 2% 4% 431
Baluchistan 77% 14% 2% 2% 6% 377
Total 72% 18% 1% 3% 6% 1976
Table 10: % of Pre Menstrual Information

Punjab 65% 35% 1079
KPK 71% 29% 649
Sindh 76% 24% 565
Total 72% 28% 2751
Table 11: % of Menstruation Age (first time)

District 9 to 10 11 to 12 13 to 14 15 to 16 17 & above Total
Punjab 8% 19% 55% 17% 0% 1079
KPK 12% 43% 38% 6% 0% 649
Sindh 6% 25% 60% 9% 0% 565
Baluchistan 2% 32% 46% 18% 2% 458
Total 7% 28% 51% 13% 0% 2751
Table 12: % of Opinion about menstrual age

District 8 to 9 10 to 11 12 to 13 14 to 15 16 & above Total
Punjab 4% 35% 51% 9% 2% 1079
KPK 13% 31% 52% 4% 0% 649

Sindh 3% 30% 52% 15% 0% 565
Baluchistan 4% 19% 69% 6% 1% 458
Total 6% 30% 54% 9% 1% 2751
Table 5: % of Pre Menstrual Preparation

Punjab 73% 27% 1079
KPK 58% 42% 649
Sindh 72% 28% 565
Total 69% 31% 2751
Table 6: % of Type of problems during Menstruation
District Pains Aggression Weakness of Travel issues of Bad of No Total
Feeling Issue
Punjab 50% 26% 3% 8% 0.19% 0.13 1079
KPK 44% 5% 18% 11% 0.00% 0.22 514
Sindh 53% 5% 12% 8% 0.00% 0.23 565
Baluchistan 32% 43% 9% 6% 0.00% 0.11 458
Total 44% 20% 12% 9% 0.11% 0.16 2751
Table 7: % of Menstrual Product in Use-Practices

District Cotton New Cloth Reusable cloth Pad Pads, cloth, cotton Others Total
Punjab 5% 5% 5% 69% 16% 0.3% 1079
KPK 2% 3% 4% 82% 10% 0.0% 649
Sindh 2% 14% 14% 63% 7% 0.0% 565
Baluchistan 6% 5% 13% 66% 9% 0.7% 458
Total 4% 6% 8% 70% 11% 0.2% 2751
Table 8: % of Pads Shopping Source

District Self parents mostly (mother) Friends Others Total
Punjab 46% 42% 0% 12% 1079
KPK 67% 24% 2% 7% 649
Sindh 28% 44% 0% 28% 565
Baluchistan 39% 39% 0% 22% 458
Total 46% 37% 1% 16% 2751
Table 9: % of Per cycle Pads Count

District 5 to 7 6 to 10 10 to 15 depend on flow use cloth Total
Punjab 2% 26% 35% 28% 9% 1079
KPK 1% 27% 32% 34% 6% 649
Sindh 2% 19% 32% 19% 28% 565
Baluchistan 1% 14% 29% 37% 19% 458
Total 1% 23% 33% 29% 14% 2751
Table 10: Total Amount spent on Pads

Less than
District 100-300 150-500 300-600 Above 600 No cost Don’t know Total
100
Punjab 24% 3% 33% 26% 2% 9% 2% 1079
KPK 35% 9% 31% 17% 0% 6% 2% 649
Sindh 15% 0% 31% 19% 1% 28% 6% 565
Baluchistan 15% 0% 26% 36% 3% 19% 1% 458
Total 23% 3% 31% 24% 2% 14% 3% 2751
Table 11: % of Reasons of Preferred Menstrual material

District Comfort & easy Comfort, safe, easy available No Cost & easy Total
dispose off and travelling disposing
Punjab 53% 46% 1% 1079

KPK 50% 50% 0% 649
Sindh 37% 61% 1% 565
Total 48% 52% 1% 2751
Table 13: % of Pads change (hours)

District 3-5 hours 4-8 hours 4-6 hours 5-6 hours 6-9 hours Depend on bleeding Total
Punjab 30% 24% 34% 10% 1% 0% 1079
KPK 18% 35% 31% 8% 0% 8% 649
Sindh 22% 15% 31% 29% 2% 0% 565
Baluchistan 37% 15% 28% 19% 1% 0% 458
Total 27% 23% 32% 15% 1% 2% 2751
Table 14: % of Pads Disposal Practice

District Burn Bury Cover in bag and then destroy Throw in Open Wash, dry, Total
to bin burn
Punjab 9% 5% 83% 3% 0.9% 1079
KPK 16% 6% 72% 5% 0.8% 649
Sindh 14% 2% 78% 5% 0.9% 565
Baluchistan 6% 3% 88% 1% 2.0% 458
Total 11% 4% 80% 3% 0.7% 2751
Table 15: % of Practices of house waste disposal

District Burn Burn and Bury Dumping site Bins Throw in open Private Trash Collector Total
Punjab 0.5% 0.1% 1% 23% 18% 58% 1079
KPK 0.0% 0.0% 0% 44% 14% 42% 649
Sindh 0.5% 0.0% 0% 48% 9% 42% 565
Baluchistan 0.4% 0.0% 20% 21% 6% 53% 458
Total 0.4% 0.0% 4% 33% 13% 50% 2751
Table 16: % of Brands Preference by Users

District Always Butterfly Molpad Other Always, Molpad, butterfly, Kotex, Tampax Total
Punjab 45% 23% 3% 2% 27% 914
KPK 59% 8% 3% 8% 22% 597
Sindh 46% 22% 1% 1% 30% 395
Baluchistan 41% 22% 10% 7% 20% 347
Total 48% 18% 4% 4% 25% 2253
Table 17: % of Pads availability on Shops

District Yes No Do not know Total
Punjab 80% 11% 10% 1079
KPK 76% 13% 10% 649
Sindh 59% 16% 25% 565
Total 73% 13% 14% 2751
Table 18: % of Last month pads buying status

District Yes No NA Total
Punjab 71% 19% 10% 1079
KPK 68% 26% 6% 649
Sindh 30% 42% 28% 565
Total 62% 24% 14% 2751
Table 19: % of Reasons for not buying

District In stock Parents buy Total
Punjab 54% 46% 214
KPK 50% 50% 169
Sindh 34% 66% 197
Total 45% 55% 663

Table 20: % of Food Preference during Period
District Lose Appetite Milk & Protein No choice Spicy & Sweet Total
Punjab 10% 72% 2% 15% 1079
KPK 6% 60% 2% 32% 649
Sindh 7% 64% 4% 25% 565
Baluchistan 5% 77% 8% 10% 458
Total 8% 69% 3% 20% 2751
Table 21: Handling Issues

District Bear Therapy Home Self/ Keeping No Medicine Praye Rest & Total
Pain Remedies busy warm prob. rs Sleep
Punjab 1% 3% 5% 1% 2% 15% 57% 3% 14% 1079
KPK 0% 4% 20% 1% 2% 18% 34% 1% 19% 649
Sindh 1% 2% 2% 5% 5% 26% 32% 12% 17% 565
Baluchistan 1% 2% 7% 2% 2% 13% 54% 3% 17% 458
Total 1% 3% 8% 2% 2% 17% 46% 4% 16% 2751
Exercises, heat pads, hot bottles massage and heat cream and increase water intake
Home remedies and hot drinks(tea, green tea, turmeric and hot milk, chocolate, coffee, boiled eggs, boiled herbals, soups and
honey)
Table 22: % of Beliefs about open discussion on Menstruation

District Yes No Do not Know Total
Punjab 24% 13% 3% 1079
KPK 19% 4% 0.4% 649
Sindh 14% 5% 2% 565
Total 39% 11% 2% 2751
Table 23: % of Beliefs about performing routine chores (prohibition)

District Yes No I don’t know Total
Punjab 20% 61% 19% 1079
KPK 25% 70% 5% 649
Sindh 18% 75% 8% 565
Total 21% 68% 11% 2751
Table 24: % of Beliefs about Impurity during Menstruation

Punjab 39% 56% 5% 1079
KPK 41% 53% 6% 649
Sindh 56% 37% 7% 565
Total 45% 50% 5% 2751
Table 25: % of Beliefs on Bathing (can cause swelling, and disturbance in menstrual cycle)
Punjab 68% 17% 15% 1079
KPK 51% 32% 17% 649
Sindh 58% 25% 18% 565
Total 62% 23% 15% 2751
Table 26: % of Beliefs about cold and spicy food cause health issues
Punjab 79% 12% 9% 1079

KPK 68% 21% 10% 649
Sindh 68% 18% 14% 565
Total 74% 17% 10% 2751
Table 27: % of Belief about menstrual pads cloth burning prohibition (should be washed/reused).
Punjab 24% 60% 17% 1079
KPK 24% 54% 22% 649
Sindh 24% 58% 18% 565
Total 25% 59% 16% 2751
Table 28: % of Beliefs on heavy object lifting cause issues

Punjab 51% 28% 20% 1079
KPK 76% 10% 13% 649
Sindh 63% 11% 26% 565
Total 65% 17% 17.96% 2751
Table 29: Information on Biodegradable pads

Punjab 11% 89% 1079
KPK 9% 91% 649
Sindh 5% 95% 565
Balochistan 5% 95% 458
Total 8% 92% 2751
Table 30: Willingness to buy biodegradable Pads

District Yes No Cannot Predict Total
Punjab 57% 17% 25% 1079
KPK 92% 4% 4% 649
Sindh 55% 40% 5% 565
Balochistan 54% 10% 36% 458
Total 65% 18% 18% 2751

Male Household Heads
Table 31: Shopping Lead

District Male Female Both Total
Punjab 55% 19% 26% 69
KPK 90% 0% 10% 21
Sindh 20% 80% 0% 10
Total 59% 23% 18% 135
Table 32: Grocery List Lead

District % of Male % of Female % of Both Total
Punjab 13% 62% 25% 69
KPK 19% 62% 19% 21
Sindh 100% 0% 0% 10
Total 26% 53% 21% 135
Table 33: Sanitary Pads in Grocery List

District Yes No No Idea Total
Punjab 46% 42% 12% 69
KPK 38% 62% 0% 21
Sindh 100% 0% 0% 10
Total 49% 43% 8% 135
Table 34: Menstrual Products used at home

District Always Butterfly Others Cloth No Idea Total
Punjab 55% 13% 1% 7% 23% 69
KPK 57% 5% 0% 0% 38% 21
Sindh 70% 10% 20% 0% 0% 10
Balochistan 23% 14% 34% 3% 26% 35
Total 48% 12% 11% 4% 24% 135
Others: Molped, Trust and My Lady.
Table 35: Special Brands used at Home

District Always Butterfly Others No No Idea Total
Punjab 36% 12% 4% 9% 39% 69
KPK 62% 5% 0% 0% 33% 21
Sindh 0% 10% 80% 0% 10% 10
Balochistan 26% 17% 37% 0% 20% 35
Total 35% 12% 18% 4% 31% 135
Others: Molped, Trust, My Lady, Disposable
Table 36: Monthly Spending on Sanitary Pads

District 100-250 200-500 500-1000 1000-1500 1500-2000 No Idea Total
Punjab 12% 20% 16% 14% 1% 36% 69
KPK 33% 48% 0% 0% 0% 19% 21
Sindh 50% 50% 0% 0% 0% 0% 10
Baluchistan 6% 23% 23% 14% 3% 31% 35
Total 16% 27% 14% 11% 1% 30% 135
Table 37: Willingness of males to buy Pads

District Yes, I like it Uncomfortable No Idea Skip Total
Punjab 65% 25% 1% 9% 69
KPK 29% 67% 0% 5% 21

Sindh 10% 90% 0% 0% 10
Baluchistan 34% 14% 0% 51% 35
Total 47% 33% 1% 19% 135
Table 38: Disposing methods used for Pads

District Burn Bury Put in the Waste Open No Idea Total
dustbin collector dumping
Punjab 6% 4% 25% 1% 7% 57% 69
KPK 10% 0% 19% 0% 29% 43% 21
Sindh 90% 0% 0% 0% 10% 0% 10
Baluchistan 6% 14% 43% 0% 26% 11% 35
Total 13% 6% 27% 1% 16% 39% 135
Table 39: Disposing pads in open cause environmental pollution

Punjab 70% 3% 28% 69
KPK 100% 0% 0% 21
Sindh 100% 0% 0% 10
Total 85% 1% 14% 135
Table 40: Composition of Pads

District Cotton Polyester Plastic Chemical Cloth No Idea Total
Punjab 23% 0% 10% 6% 9% 52% 69
KPK 10% 0% 24% 0% 0% 67% 21
Sindh 10% 0% 10% 0% 0% 80% 10
Baluchistan 26% 20% 26% 3% 0% 26% 35
Total 21% 5% 16% 4% 4% 50% 135
Table 41: Willingness of males to buy Environmental friendly pads

Punjab 59% 19% 22% 69
KPK 81% 0% 19% 21
Sindh 100% 0% 0% 10
Total 68% 12% 20% 135
Shopkeepers Data Analysis (Percentages)
Table 42: Number of Shops

District No of Shops
Punjab 43%
KPK 9%
Sindh 30%
Balochistan 18%
Total 100%
Table 43: Availability of pads in shops

Punjab 100% 0% 78
KPK 100% 0% 17
Sindh 100% 0% 55
Total 100% 0% 182

Table 44: Reasons for availability of specific brands at shops
District Customer Demand Depend on price Total
Punjab 100% 0% 78
KPK 100% 0% 17
Sindh 98% 2% 55
Total 98% 2% 182
Table 45: Brands available on Shops

District Always Butterfly Cleopatra Molpad Other Total
Punjab 76% 24% 3% 6% 18% 78
KPK 76% 18% 12% 0% 6% 17
Sindh 73% 27% 0% 0% 2% 55
Baluchistan 38% 47% 9% 16% 16% 32
Total 68% 29% 4% 5% 12% 182
Others represent Trust, My Lady, Rahat, onion, Cotext, Mother Care and Comfort, Daisy, Freedom, Sincere,
Molfix, P&G, Density, Neatex, Spot free, Cotext, Fair lady, Hygiene, Onion, Comfrey, Miss More, etc.
Table 46: Types of buyers

District Male Female Both Kids Total
Punjab 13% 37% 42% 8% 78
KPK 12% 88% 0% 0% 17
Sindh 0% 64% 18% 18% 55
Balochistan 6% 88% 6% 0% 32
Total 8% 59% 25% 9% 182
Table 47: Income levels of buyers observed by shopkeepers

District Mix Upper class Middle class Middle class and Upper and middle Total
student class
Punjab 35% 8% 31% 19% 8% 78
KPK 76% 0% 6% 0% 18% 17
Sindh 78% 0% 18% 2% 2% 55
Balochistan 91% 0% 9% 0% 0% 32
Total 62% 3% 21% 9% 5% 182
Table 48: Awareness sessions by Sanitary pad companies or NGOs

Punjab 8% 92% 78
KPK 0% 100% 17
Sindh 16% 84% 55
Total 8% 92% 182
Table 49: Sale promotion of Pads by companies

District Always Butterfly Molpad My lady No Total
Punjab 13% 5% 3% 0% 79% 78
KPK 0% 0% 0% 0% 100% 17
Sindh 13% 11% 0% 0% 76% 55
Balochistan 6% 9% 3% 3% 78% 32
Total 10% 7% 2% 1% 80% 182
Table 50: Disposing practices of Sanitary Pads

Put in shopping bag and dump in the
District Buried Throw away No idea Total
wastes
Punjab 1% 3% 1% 95% 78
KPK 0% 0% 0% 100% 17
Sindh 0% 0% 0% 100% 55

Balochistan 0% 19% 0% 81% 32
Total 1% 4% 1% 95% 182
Table 51: Composition of Sanitary Pads

District Cotton Plastic Chemicals Cotton, Plastic and No idea Total
Polyester
Punjab 1% 8% 23% 0% 68% 78
KPK 0% 12% 0% 0% 88% 17
Sindh 0% 0% 0% 0% 100% 55
Balochistan 16% 0% 3% 34% 47% 32
Total 3% 4% 10% 6% 76% 182
Municipal Bins reported: TMA, WSSP, CDA, RDA
Table 52: Decomposition duration of Sanitary Pads

Province Hours Days Months Years Never Risks for Animal No knowledge Total
Punjab 0% 8% 6% 1% 1% 4% 79% 78
KPK 0% 0% 0% 18% 0% 0% 82% 17
Sindh 0% 0% 0% 0% 0% 0% 100% 55
Baluchistan 22% 0% 0% 0% 3% 0% 75% 32
Total 4% 3% 3% 2% 1% 2% 85% 182
Three shopkeepers (Muzzafargurh , Quetta, and Lahore) said, they heard about biodegradable pads.
Table 53: Knowledge about Biodegradable Pads

Province Yes No Total
Punjab 3% 97% 78
KPK 0% 100% 17
Sindh 0% 100% 55
Total 2% 98% 182
Table 54: Willingness to sell biodegradable products

Province Quality Price & Price New Products Sales Yes environmental & Total
Demand difficult health friendly
Punjab 6% 65% 3% 1% 24% 78
KPK 0% 76% 0% 0% 24% 17
Sindh 0% 44% 27% 29% 0% 55
Balochistan 25% 44% 25% 0% 6% 32
Total 7% 56% 14% 9% 14% 182

Annex IV: Ethical Protocols and Consent Form(s)
Protocol and Consent for FGDs
I. Introduction/Purpose:
Assalam-o- Aaikum, I am ______________, and this is my colleague _____________. We are
working on study about menstrual hygiene management for girls/women. You are being asked to
participate in a group discussion with other girls/women. We would like to talk about experiences
girls/women have when they having their monthly periods; for instance, how they deal with their
menses, what hygiene practices they are aware of and what they know about menstruation, beside that
we will also ask about the material they use for menstruation management . We will use the
information that you all share with us today to suggest you are better and environment friendly MHM
material.
II. Procedures:
Our discussion will last between 45 minutes and two hours. All opinions are important to us. If you
agree with others in this room, please share. If you don‘t agree, please share. There are no rights or
wrong answers. Share your ideas, feelings and opinions coming in your mind without any fear of
being evaluated. I know this is a private topic. If you‘re not comfortable talking, you do not have to
and you can leave at any time.
III. Language:
We speak ________ languages, so please feel free to use these languages while you communicate
with us.
IV. Participation:
Your participation is completely voluntary, no one force you to participate. If you do not like a
question you do not have to answer it. You are free to stop at any time. We would like to tape record
what you say so that we do not miss anything. We are going to take notes too. I‘m going to put the
recorder here. If at any time, you feel uncomfortable, tell me and I will press this button and the
recorder will be off. Once you have finished saying what you need to say without the microphone on,
I will press this button again and resume recording. However, we would like to invite everybody to
share what they know and their ideas. Your input is very important because what you say can help us
to understand the issues girls face and find good solutions.
V. Confidentiality:
We will not tell anyone what you say. We will only share the ideas you have with the people in the
research team. None of your names will be recorded to assure your privacy. Members of the research
team will be the only people that listen to the recording of our conversation. We also ask that each of
you keep this conversation private. Please do not share it with others outside the group. We ask you
this because if people talk about the discussion afterward, other people outside of this conversation
may know what you said and may talk about or tease you. We do not want this to happen. To prevent
this, we should keep this private. Are there any questions?
VI. Contact Information

If you have any questions or concerns about this research and your right as a participant, you may
contact -----------------------------
Assent:
If you would not like to participate, you do not have to say anything. You may excuse yourself from
the discussion. If you would like to participate, please stay seated. I will now turn the recorder on or
start taking the notes. We will go around the room and I will ask you individually if you are willing to
participate. If you are willing to participate, once it is your turn, please say ‗Yes, I will participate.

Declaration of Consent for the Use of Photos/ Videos
In connection with _____________________________________ (Name of project or event),

I hereby consent to photos and/or videos of or group members for
Group discussion
(Child‘s/children‘s name(s)__________________________________________ being created and
used by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH for the following
purposes:
 Publication as part of GIZ‘s public relations work, e.g. in event documentation, flyers,
brochures, GIZ‘s websites and social media channels;
 Forwarding to GIZ‘s clients and project partners for use in their public relations work.
You have the right to inquire at any time about the type of data processing, and to have the data
corrected if they are incorrect, or to demand that their processing be restricted or that the data be
deleted.
Furthermore, you may withdraw your consent at any time to use of the photos and recordings. Please
email withdrawal of your consent to __051-111-111-920____. Please insert here either the email
address of your function or your own email address. This does not affect the lawfulness of any
processing of your data before your consent was withdrawn.
If you believe the data processing to be unlawful, you may contact GIZ‘s data protection officer
(datenschutzbeauftragter@giz.de), or lodge a complaint with the responsible data protection
supervisory authority – the Federal Data Protection Commissioner (BfDI) (poststelle@bfdi.bund.de).
Family name ______________________________
Given name________________________________
Date of recording/ Photo______________________
Country of recording/photo___________________
Date, place_________________________________
Signature__________________________________

Women Consent for Photos and FGDs Participation
Group Photos permission

# Name city Date Participants
(Please tick the box)-Signature
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Final Report - Market Feasibility For Bio-Degradeable Sanitry Napkin in Pakistan - Oct 17, 2022

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Final Report - Market Feasibility For Bio-Degradeable Sanitry Napkin in Pakistan - Oct 17, 2022

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Market Feasibility for Biodegradable

October 17, 2022

Prepared by Prepared for

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan i

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan ii

AGAHE Association for Gender Awareness & Human Empowerment

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 1

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 2

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 3

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 4

1.1. Objectives of the Assessment

1.2. Research Design & Methodology

1.2.1 Research Method

1.2.2 Sampling Technique

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 5

1.3. Finalization of Market Feasibility Assessment Tools

1.3.1 Knowledge, Practices and Beliefs of Women

1.3.2 Beliefs, Knowledge and Willingness of Men

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 6

1.4. Quality Assurance and Data Analysis

1.6. Study Challenges

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 7

2.1. Importance of Menstrual Hygiene

2.2. Global Perspective

Globally, women constitute 49.6% of the population.2 Menarche, or the commencement of

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 8

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 9

Agenda 2030 on ‗Sustainable Development‘ promotes a holistic approach to development and

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 10

2.3. Pakistan’s Layout Regarding MHM

2.3.1 Social Factors

2.3.2 Economic Factors

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 11

2.3.3 Environmental Factors

2.4. Available Studies from Pakistan

2.4.1 IRSP Studies

2.4.2 UNICEF Studies

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 12

2.4.3 WaterAid Studies

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 13

2.5. Initiatives to include MHM in Educational Curriculum

2.5.1 Educational Materials

2.5.2 MHM in Schools’ Practice

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 14

2.6. Coordination Platforms/ Mechanisms

2.7. Use of Social Media

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 15

3.1. Number of Respondents

Punjab KP Sindh Balochistan Total

Figure 1: Number of Respondents

Table 1: Number of FGDs and Participants

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 16

3.2. Types of Respondents

3.2.1 Respondents from Survey

Household students Working Women

Figure 2: Type of Respondents

3.2.2 Number of Respondents in FGDs

3.3. Male Household Head/Guardian Education

Market Feasibility for Biodegradable Sanitary Napkins in Pakistan 17

20% 14% 21% 17%

Illitrate Primary Middle Matric Secondry B.A M.A & above

Figure 3: Education Level of Parents