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Menstrual cup potentially to provide innovation and affordable hygiene in emergencies

June 13, 2011

Menstruation in emergencies
Women’s menstruation does not stop just because there is an emergency. Besides the practical issues of obtaining, washing and disposing of sanitary towels, women may have cultural issues to deal with. In some societies, women have to go somewhere private whilst they are menstruating. If the whole household is living in a single room or tent, this can be very difficult, says Paul Sherlock, OXFAM GB. Pads, old cloth, cow-hide or leaves to use during menstruation is simply not available in emergencies or refugee camps. In for example Ikafe, some refugees found themselves unable to use anything (Lina Payne, Social Development Consultant).

Disposable sanitary towels are the most frequently used methods to manage menstruation. In emergencies they may however not be available, and in other resource-poor settings, they are often too expensive and unaffordable to most adolescent girls and women who need them. Consequently these women and adolescent girls resort to unhygienic methods. Lack of access to sanitary products confines some women and adolescent girls at home during their periods, restricting their mobility and undermining their participation in education, economic and social activities. (From policy brief see below)

Menstrual cups
The menstrual cup (cup made of medical silicone rubber that is inserted into the vagina to collect menstrual blood) may be an appropriate new technology both affordable and reusable for emergencies for all women and girls, where the normal menstrual methods such as tampons and pads may become unavailable and storages may run out. One woman uses up to 22 items of sanitary protection every period. Regardless of flow, one woman only needs one menstrual cup, and it lasts for several years, making it the most economical sanitary product on the market.

The commercial menstrual cup has been around at least since the 1930s, when the American Leona W. Chalmers patented it. An earlier patent also exists for the Daintette cup -but its history is less clear.

Women today can buy the reusable The Keeper, sold since the late 1980s; the one-time use Instead, which Ultrafem started selling in the fall of 1996 in the western part of the U.S.A.; the British Mooncup; the Canadian DivaCup, made of silicone; and the Finnish Lunette cup.

Feasibility of menstrual cups in emergencies
There is unfortunately very little data on the feasibility of menstrual cups for emergency situations. The big issue with menstrual cups is the lack of scientific and real knowledge on their safety in places where clean water is not easily available, such as in refugee camps. While menstrual cups can last up to 12 hours before needing to be emptied and cleaned, there is sparse data on the effect of dropping, latrine hygiene, dirty hands, sharing with friends/relatives/neighbours, or exchanging for ‘essentials’, the potential for menstrual cups to carry infection etc. In refugee settings this would be a potential problem with all the known water and sanitation challenges. On the other hand, if there is nothing else, and if women would otherwise need to get up in the night to change or go to a latrine and risk sexual violence, then they are a positive contribution. Overall however, the unknowns probably outweigh the knowns.

A number of international researchers are involved with setting up studies to address  some of these issues, with expected results in a year or so. For example, Vivian Hoffmann at University of Maryland, is leading some separate and compelling work comparing demand for different menstrual solutions which will likely include the cup in a sub-group of women.

The technology would certainly need to be studied, and if deemed appropriate, be promoted to be included more widely in emergency hygiene kits. For immediate dispatch after a disaster, menstrual cups cold be included in the shipments and complementing other immediate interventions of water and sanitation. For the moment, there are “comfort kits” for personal hygiene, which also include underwear, something which is important to keep sanitary pads in place.

If any of the readers of this blog is interested in testing the use of menstrual cups in an emergency setting, please get in touch with ase.johannessen@gmail.com. Aspects to think of are many. Cups cant just be put into the comfort kit. Training how to use, how to clean/sterilise, importance of washing hands, not sharing with others in between periods, care if there is an open wound/STI, follow up by a nurse to check for trauma or infection would all be important “software” to accompany a menstrual cup.

Studies
The studies on menstrual cups are limited to the Nairobi (African Population Health and Research Centre), Nepal (Oster and Thornton), and a ‘feasibility’ study in Zimbabwe (Averbach). Links to these studies are/will be included below:

For menstrual cups used in low-income settings you can read more on the policy briefs available on the on the SuSanA website by The African Population and Health Research Center (APHRC), Nairobi, Kenya found here:

1) Use of menstrual cup by adolescent girls and women: Potential benefits and key challenges

2) Attitudes towards, and acceptability of, menstrual cups as a method for managing menstruation: Experiences of women and schoolgirls in Nairobi, Kenya

3)  Experiences and problems with menstruation among poor women and schoolgirls in Nairobi, Kenya

Available as purchase articles:

4) Menstruation and Education in Nepal, by Emily F. Oster and Rebecca L. Thornton. NBER Working Paper No. w14853

5) Emily Oster & Rebecca Thornton. 2009. Determinants of Technology Adoption: Peer Effects in Menstrual Cup Take-Up

6) Emily Oster & Rebecca Thornton. 2010. Menstruation, Sanitary Products and School Attendance: Evidence from a Randomized Evaluation

7) Sarah Averbach, Nuriye Sahin-Hodoglugil, Petina Musara,Tsungai Chipato, Ariane van der Straten. 2009. Duet® for menstrual protection: a feasibility study in Zimbabwe. Contraception 79 (2009) 463–468

Other references for the blog text (two quotes): Menstrual Hygiene and Management in Developing Countries: Taking Stock, November 2004 By Sowmyaa Bharadwaj andArchana Patkar

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3 Comments leave one →
  1. June 18, 2011 4:52 am

    Worthwhile but not always easy to use

  2. Bec permalink
    January 22, 2012 9:47 am

    I recently bought a Mooncup (although I have not yet had a chance to use it) and the question of whether it could be used in emergency situations or developing communities has been persistently playing on my mind. It’s great to come across evidence that this area of research is being developed 🙂

    Thanks SuSanA for publishing this information.

    Well done and congratulations to those exploring this avenue!

Trackbacks

  1. Diva Cup Concerns in Africa | Djibouti Jones

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