Viewpoint

Period product disposal in India: the tipping point

Ashna Bijua,b,∗
a
Gonville & Caius College, Trinity Street, Cambridge, CB2 1TA, United Kingdom
b
School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, United Kingdom

Summary The Lancet Regional

Health - Southeast
The UN projects that India is now the world’s most populous nation. However, with this rising population comes a
Asia 2023;15: 100214
significant need for safer period product disposal systems. Current practices include local incineration or burial of
Published Online 12 May
sanitary products, with harmful health and environmental impacts. This Viewpoint proposes a three-sphere model to 2023
develop long-term solutions for sanitary waste disposal in India, focussing on education, national organisation, and https://doi.org/10.
sustainability. Proposed solutions are developed and criticised with a consideration of why change has been limited 1016/j.lansea.2023.
thus far. A case study in Kerala is considered where all three spheres are incorporated with the help of a local non- 100214
governmental organisation, however, with limitations that could have been alleviated with national organisation. In
effect, the Indian government must develop a centralised system for tackling sanitary waste disposal before a tipping
point is reached.

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).

As India is estimated to have overtaken China as the
world’s most populous nation,1 menstrual hygiene man-
agement and safe disposal of sanitary products is also
becoming a growing concern. Even though 36% of India’s
355 million menstruating women use sanitary pads,2 they
are met with improper waste facilities, leaving poor out-
comes for future generations. There is insufficient na-
tional coordination of sanitary waste collection, disposal,
and transportation, which are compounded by social
stigmas associated with menstruation.3,4 People who
menstruate are then forced to develop their own strategies
of disposing period products, with detrimental conse-
quences. Products are thrown into nearby fields and un-
used wells; flushed down toilets; buried; or burned in
people’s backyards. More well-off individuals can afford
to pay for private waste collection agencies, though it is
still unclear where this waste is disposed. Despite inade-
quate sanitary waste management being publicly
acknowledged, little is being done on a national level to
solve this issue. Thus, this Viewpoint calls for change
before a tipping point is reached.
Improper sanitary waste management has detri-
mental health and environmental impacts.5 Commercial
sanitary pads are disposable and nonbiodegradable,
potentially taking up to 800 years to break down into
microplastics. Marine ecosystems are altered when or-
ganisms ingest these microplastics, and elevated levels
of microplastics build up in food chains.6 When flushed
in toilets, super-absorptive materials like polyacrylate
absorb water, resulting in sewage backflow. This poses
its own health problems for individuals living near water
pipelines and canals. When deodorised products are
*Gonville & Caius College, Trinity Street, Cambridge, CB2 1TA, United
Kingdom.
E-mail address: ab2540@cam.ac.uk (A. Biju).
buried, organochlorines in the products disturb the soil
microflora. Moreover, menstrual blood infected with
HIV or hepatitis retain their infectivity in soil, risk-
ing water safety.5 Conservancy workers unblock water
systems often without proper protective equipment,
exposing themselves to toxins and pathogens.
Household-level incineration of waste is marginally
better, however, burning of inorganic material releases
carcinogenic dioxins which are persistent organic pol-
lutants. Overall, safe period product disposal is essential
for health and the climate.
This Viewpoint proposes a three-sphere model for
solving period product disposal involving education,
organisation, and sustainability, shown in Fig. 1. Each of
these three spheres will be explored in detail, with an
evaluation of challenges to implementing this model
(perhaps explaining why change has been limited in
India so far).
First, professionals and social workers could provide
education on menstrual hygiene management to young
girls and boys, especially focussed on tackling social
stigmas around periods. Stigma is deeply entrenched,
and is influenced by cultural, religious, and patriarchal
values.4 Indeed, in many parts of India, there is a long
history of perceiving menstruation as an impure phe-
nomenon, restricting women on their periods from
cooking, bathing, praying and even entering the main
part of the house.3 Annual educational workshops on
menstrual hygiene management could be incorporated
into the national school curriculum with endorsement
from the Ministry of Education. It is important to make
this available not just to girls because this helps des-
tigmatise menstruation and provides education for
people who menstruate but do not identify as women.
This education should extend to adults in the commu-
nity, with financial or social incentives for engagement.

www.thelancet.com Vol 15 August, 2023 1

 Viewpoint
Fig. 1: Proposed three-sphere model for tackling improper period product disposal.
Moreover, primary care physicians could do more to
educate patients on menstrual hygiene management
and treat them holistically, especially as members of a
trusted profession.3 Overall, educational solutions must
originate at a root-level to ensure long-term change.
Second, reusable sanitary products should be encour-
aged as a more sustainable alternative.7 Menstrual cups
and reusable cloth pads can last from 2 to 10 years,
depending on manufacturer and customer use. Benefits of
such products include reduced usage and unsafe disposal
of commercial sanitary pads, reducing the health and
environmental impacts detailed earlier. However, reusable
period products are not widely used in India. They are
initially more expensive to buy (though cost-effective in the
longer run) and are not as widely advertised or sold. There
are fears around insertion and removal of menstrual cups
breaking the hymen, with many women worrying they
may ‘lose their virginity’ (virginity culturally associated
with intact hymen).7 These beliefs could be challenged with
educational workshops destigmatising sexual health and
virginity, as detailed earlier. Currently, such schemes are
not prevalent and would require significant financial and
governmental support. Indeed, all these factors may
contribute to the limited advertising, marketing, and sales
of menstrual cups in India.
Third, the national government must take initiative
to organise safe sanitary product disposal. The onus
should not exclusively be on individuals, local charities,
or non-governmental organisations. A centralised sys-
tem is needed to create sustainable solutions for the
long-term. This could be aided by existing guidance
from international health organisations such as UNI-
CEF.8 The co-operation of several Ministries in India
would be needed for a large-scale effort to solve this
problem, including the Ministry of Women & Child
Development and the Ministry of Health & Family
2 www.thelancet.com Vol 15 August, 2023
Welfare. An effective strategy would be to reward or
penalise period product manufacturers who play a sig-
nificant role in influencing consumer habits. For
example, Niine Sanitary Napkins provide biodegradable
bags with their products, and have also been partnering
with schools to install incinerators. In 2021, the Minis-
ter of Environment, Forest and Climate Change made it
mandatory for all manufacturers to provide such
biodegradable bags, however, there is little evidence on
how this has been received.9 Furthermore, there is
limited incentive for the government to improve sani-
tary disposal systems due to a lack of academic literature
to indicate demand. This, in turn, leads to an insuffi-
cient push for research into menstruation, resulting in a
negative cycle of inaction. This is compounded by social
stigma to which members of government are just as
susceptible as the public. Overall, despite recent rec-
ommendations from the Central Pollution Control
Board in India to improve sanitary waste disposal,10 they
are not sufficiently implemented. Further research into
the barriers preventing this may encourage the Indian
government and period product manufacturers to take
this issue seriously.
A case study where the three spheres are considered
is in Muhamma, a village in the Alappuzha district of
Kerala, hoping to be the first synthetic pad-free village in
India.11 In 2019, the village council distributed 5500
cloth pads and 500 menstrual cups, for a subsidised rate
with the help of a non-governmental organisation. This
was supplemented with awareness campaigns teaching
people how to use these reusable alternatives, and the
importance of them.11 However, there are limitations to
this initiative as a model case study as no follow-up has
been conducted to study the villagers’ continued use of
reusable period products. This initiative would also have
benefitted from increased funding and national

organisation to improve accessibility for individuals who
could not afford the subsidised rate, by instead distrib-
uting products for free.
According to the UNICEF theory of change for
menstrual health management, the lack of supportive
systems for waste disposal is a significant barrier to
equitable outcomes in any country.8 In India, though
local schemes aim to tackle sanitary waste disposal, they
are limited by funding and research, and more awareness
and organisation is needed on a national level. The In-
dian government must take charge to develop long-term
solutions for sanitary waste disposal, based on the pro-
posed three-sphere model. A centralised system is
needed for national change, and this must be done before
a physical, and metaphorical, tipping point is reached.
Contributors
AB conceptualised and wrote the paper.
Declaration of interests
None.
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