Knowledge, Attitude, Perception and Practices towards Disposal of Sanitary Napkins among Young Females: A Cross-Sectional Study

ABSTRACT

Background:

Almost 70% of women residing in urban areas and 48% of women in rural areas use sanitary napkins in India. According to menstrual health alliance India (MHAI), single sanitary pad will take about 500-800 years to decompose as the plastic used in manufacturing is nonbiodegradable and causes severe noxious effects contributing to global warming through the production of planet warming fuels which eventually have severe impact on environment sustainability. Hence, the study was undertaken to contribute the evidence for the “Clean and Green India”.

Aim:

To know the perception and practice of disposal of sanitary napkins among young college-going females in India.

Materials and Methods:

A cross-sectional study was conducted throughout the country employing a self-administered questionnaire using a survey link sent through social media. Data collected were analyzed and interpreted using SPSS version 20.0.

Result:

The study population comprised 484 young college girls with a mean age of 20.92 ± 1.86 years and 96.9% of them are using sanitary napkins as menstrual absorbent aids. The most common method employed for the disposal of sanitary napkins was dumping them in the bin (87.4%). About 63.2% of them had no knowledge about sanitary napkin-burning machines. Around 92% think that improper disposal of sanitary napkins can cause health problems.

Conclusion:

The findings from the study revealed that a significant number of women were practicing noneco-friendly disposal methods and menstrual hygiene aids which are a bane to the ecosystem. Study warrants the education and training of females to achieve a green and clean sustainable India.

INTRODUCTION

In India, modernization, industrialization, and economic expansion resulted in massive solid waste production per capita and remained a global concern and it has been exacerbated by phenomenal population expansion, high urban density, diversified culture, changing dietary habits, and lifestyles.[1] Massive solid waste generation per capita in India varies between small towns and cities, ranging from 0.17 kg to 0.62 kg per person per day.[2] Approximately 336 million menstruating women in India, of which 36% use disposable sanitary napkins, on average, a woman throws away about 150 kg of nonbiodegradable absorbents which is deleterious to the environment and health. Many countries have waste disposal management in relation to faecal and urinary waste but management of menstrual practise around the world is still inadequate. Eventually, the sanitary pad or napkins used during menstruation form domestic solid waste collected in the garbage bins.[3] In a developing country like India, toilets lack sanitary napkin discarding bins. In urban areas, the disposal is done along with solid waste management whereas in rural areas they may be buried, burned, and thrown in the garbage or latrine pits.[4,5,6] Therefore, the research was conducted to gain insights into the level of awareness regarding the proper disposal of sanitary napkins among young college-going females across India.

Aim and objectives

To know the perception and practices of disposal of sanitary napkins among young college-going females in India. To assess the knowledge of various disposal methods of menstrual waste. To assess the practice of menstrual waste disposal management. To know the perception on disposal of menstrual waste.

MATERIALS AND METHODS

A cross-sectional study was conducted among 484 participants throughout the country and unanimous data was collected using Google Forms. The study consists of pretested and validated 13 self-administered, semi-structured questions in the English language with four questions related to knowledge, three questions on attitude, three questions on practice, and two questions on perceptions with Cronbach’s alpha varied between 0.79 and 0.83 indicating the acceptance of the questionnaire. A survey link was circulated through social media (WhatsApp groups) and the participation was voluntary.

Statistical analysis

SPSS 20.0 was used for analysis using descriptive statistics and proportions for the categorical variables with a statistical significance level set as P < .05.

RESULTS

A total of 484 responses were received. Of 484 students, 461 were undergraduates and 23 were postgraduate students, and among them, 60.5% were staying in hostel. The mean age of the study population was 20.92 ± 1.86 years while their age range was 18-27 years. The majority (96.9%) used sanitary napkins as menstrual absorbent aids, whereas only 0.4% used tampons [Figure 1]. The most common method employed for the disposal of sanitary napkins was dumping them in the bin (87.4%) and about 63.2% of the students had no knowledge about sanitary napkins–burning machine [Figure 2].

Figure 1.

Chart depicting the usage of menstrual absorbent aids

Figure 2.

Chart depicting the method of disposal of menstrual absorbent aids

DISCUSSION

In past, cloth was used as menstrual absorbent aid by most of the women. It is a sustainable sanitary option as it can be hygienically washed and dried in the sunlight and the waste generated is very minimal. It is believed that despite the availability of new aids, people in the past were more hygienic and healthier compared to the current generation. Now improper disposable disposals are increasing, which are being a concern to the humanity. The menstrual hygiene practices were impacted by cultural norms, parental influence, individual preferences, and the socioeconomic status of an individual or the family. There are various beliefs referring to the misconceptions and the attitudes pertaining to menstruation for a given culture or religion. The beliefs, knowledge, and practices were all interlinked to each other and were important in menstrual hygiene management. These norms can be a boon or bane in the path of practicing better menstrual hygiene practices.[5] Different perceptions were observed regarding the restrictions on routine work activities, cooking, bathing, worshipping, and on consumption of certain foods because of considering menstruation as a process of dirt and polluting.[6] This study explored the current conditions of disposal and management of sanitary napkins; 87.4% of the respondents use dumping bins to dispose their used sanitary napkins which is to be collected by the routine local trash collectors as of part of domestic waste disposal system and these findings are in accordance with the study conducted[6] where 97.4% of the study participants considered to dispose their sanitary pads into the bins. However, this scenario was contradicted with the study, where 19.8% of the participants responded that they felt difficulty in finding the bins to dispose their sanitary napkins and this is consistent with the results observed in the study conducted[7] which showed that there was a lack of sanitary bins and facilities in developing countries. The present study shows that about 9.5% of the participants follow the method of burning as a disposal practice which is inconsistent (3.6%) with the study conducted[8] among adolescent girls in Chennai. In the present study, we have observed a significant number of girls have reported that they were embarrassed because of a lack of an adequate disposal system. The majority of the respondents (96.3%) reported that they conceal the used sanitary pads before disposal [Figure 3] of which 85.1% wrapped in paper and about 12.9% concealed in the plastic bags [Figure 4] which is similar to the previous studies.[9] Moreover, this study reports that a significant number of girls, that is, 45.7% felt that the method of their sanitary pad disposal was environmentally friendly and about 25% were unaware of the eco-friendliness of their disposal method.[10] These observations highlight the importance of creating awareness among females about sustainable and environmentally friendly disposal methods, and making them readily available in public places. This would be a great step towards achieving the goal of “Clean India - Green India”. It is evident from this study that there still exists the disposal method of throwing into open areas which constitutes about 0.6% of the various disposal methods creates an unusual nuisance and creates a huge risk of disease transmission.[11]

Figure 3.

Distribution of study participants based on the practice of disposal of sanitary napkins

Figure 4.

Chart depicting the material used to wrap sanitary napkins

Generalizability

The governing bodies should establish a platform that should be gender inclusive for enlightening with the experts and the civil societal organizations. Although there were several initiatives by governmental and nongovernmental bodies for the promotion of better menstrual hygiene among adolescent girls in the age group of 10-19 years in rural areas. It is imperative for all the females in the country to get access for such schemes which could promote an enhanced menstrual health. Initiatives such as “Not Just a Piece of Cloth,” “Green India,” and “Free Days” should be included in the policy for the betterment of women’s health and to maintain the ecosystem.

Recommendations for the management of menstrual waste

1. The government should enact new standards for the proper disposal and management of menstrual wastes.

2. As the disposal of menstrual waste is a major concern which affects the health and environment.

3. The government should allocate funds to the Municipal Corporation or nongovernmental organizations for the development of women-friendly restrooms.

4. Menstrual products should be distributed free of charge in schools and educational institutions.

5. Manufacturers of sanitary products should employ environmental-friendly ingredients to prevent soil and water pollution and speed up the decomposition process.

6. Menstrual hygiene management should be a component of student’s curriculum.

7. Installing semi-automatic sanitary napkin dispensing machines that operate by inserting a coin into a slot can be a great addition to restrooms. It can help ensure that women have access to necessary sanitary products, while also providing a convenient and easy-to-use solution.

8. There should be a separate collection system for menstrual waste that does not jeopardize women’s privacy and dignity.

9. Educational institutions and public places should provide space to maintain menstrual hygiene measures which are of utmost importance for females.

Limitations

Despite with the interesting findings from this study, the data extracted were based on the convenience sampling method and the age group of the participants was between 18 years to 27 years. Also, information regarding the socioeconomic status, cultural practices, and religion were not considered in the study. The strengths of the study include the environmental aspect and the perceptions of the individuals who participated in the study. Further research should be done on females with the more diverse sample in terms of age, cultural practices, and socioeconomic status would yield more information that could further help to change the disposal system and for the better maintenance of the environment, for framing the guidelines and there is a need for the revisit to the reusable sanitary napkins instead of disposable (single use) which saves the money and decreases the waste.

CONCLUSION

Hygiene and sustainability can only be accomplished in the long term through education. Young women should be made aware of the latest menstrual products, different manufacturers, government legislation, and so on through social and electronic media. To avoid the problem of disposal, emphasis should be placed on the usage of biodegradable and reusable sanitary or cloth pads. Sanitary napkin–burning machines should be deployed in schools and communities if at all practicable. There is indeed a critical need to encourage adolescents to engage in hygienic and safe practices at the school level.

Financial support and sponsorship

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

There are no conflicts of interest.