See teaching girls in India to make washable pads (here, too) - Nineteenth-century Norwegian washable pads - Italian washable pad, probably from the 1890s
See Chinese belts and pads, from 2000 and 2005. - Chinese pad and panty pad - Japanese pad, older
More belt topics
Many American belts - See how women wore a belt (and in a Swedish ad). See a modern belt for a washable pad and a page from the 1946-47 Sears catalog showing a great variety - ad for Hickory belts, 1920s? - Modess belts in Personal Digest (1966) - drawing for a proposed German belt and pad, 1894 - ads for early 20th-century Japanese belts - belts and washable pads from the 1902 and 1908 Sears, Roebuck catalogs - belt from Jordan, Marsh & Co. catalog, Boston, 1891 - German belt (from Bilz), about 1890
Suspenders to hold pads (U.S.A., 19th century)
Snap-on style washable pad -Washable pad with belt - See how women wear a belt with a pad - see a Swedish ad showing a belt and pad - German pattern for washable pads, probably before 1900 - And see a menstrual sponge
DIRECTORY of all topics (See also the SEARCH ENGINE, bottom of page.)
CONTRIBUTE to Humor, Words and expressions about menstruation and Would you stop menstruating if you could?
Some MUM site links:
homepage | LIST OF ALL TOPICS | MUM address & What does MUM mean? | e-mail the museum | privacy on this site | who runs this museum?? |
Amazing women! | the art of menstruation | artists (non-menstrual) | asbestos | belts | bidets | founder bio | Bly, Nellie | MUM board | books: menstruation and menopause (and reviews) | cats | company booklets for girls (mostly) directory | contraception and religion | costumes | menstrual cups | cup usage | dispensers | douches, pain, sprays | essay directory | extraction | facts-of-life booklets for girls | famous women in menstrual hygiene ads | FAQ | founder/director biography | gynecological topics by Dr. Soucasaux | humor | huts | links | masturbation | media coverage of MUM | menarche booklets for girls and parents | miscellaneous | museum future | Norwegian menstruation exhibit | odor | olor | pad directory | patent medicine | poetry directory | products, current | puberty booklets for girls and parents | religion | Religión y menstruación | your remedies for menstrual discomfort | menstrual products safety | science | Seguridad de productos para la menstruación | shame | slapping, menstrual | sponges | synchrony | tampon directory | early tampons | teen ads directory | tour of the former museum (video) | underpants & panties directory | videos, films directory | Words and expressions about menstruation | Would you stop menstruating if you could? | What did women do about menstruation in the past? | washable pads
Leer la versión en español de los siguientes temas: Anticoncepción y religión, Breve reseña - Olor - Religión y menstruación - Seguridad de productos para la menstruación.

Menstrual Hygiene and Management in Developing Countries: Taking Stock,
November 2004
Page 1
(Pages 2 - 3)

By Sowmyaa Bharadwaj and Archana Patkar


The recently published HYPERLINK "" JMP report, Meeting the MDG drinking-water and sanitation target: A mid-term assessment of progress (2004) is a staggering reminder that we stand to miss the targets on Sanitation in both Africa and Asia. Our own work over the past decade in the water and sanitation sector has however made us acutely aware of the absence of certain issues from the policy debate on sanitation and water.

The last decade has seen a widening of the sanitation issue to include the crucial environmental health related areas of wastewater and solid waste management particularly in urban and peri-urban areas. Most environmental health initiatives have the overall objective of reducing childhood morbidity and mortality in developing countries by reducing exposure to agents of disease and to environmental hazards that exacerbate disease. Priority areas include water supply and sanitation; solid waste management; vector control; infection control, including medical waste management and improved hygiene in health facilities; integrated programming of population-health-environment activities in areas of sensitive biodiversity; and indoor air pollution. Despite the obvious synergy between many of the specific areas outlined in the list above and menstrual hygiene and management, our search yielded very little subtext on menstrual hygiene or management.

The reproductive health, preventive health and right-based literature also failed to discuss various rights based aspects of the issue or practical and strategic needs of women and focussed primarily on the symptoms and causes of toxic shock syndrome and dysmenorrhoea.

Overall the absence of MHM in the policy debate and hence in investments and action, is striking. This, points to a glaring need to highlight this issue in the policy debate together with practical work on what adolescent girls and women require to manage their menstrual needs in terms of materials, education and facilities for management and disposal.


This paper collates our findings from a serious effort to take stock of the current thinking, practices, barriers, investments and action linked to this issue. It is based on wide electronic consultation and secondary desk review with key stakeholders in the area of health, hygiene, water and sanitation and women's rights and also incorporates the knowledge and experience from more than a decade of first-hand experience in water, sanitation and reproductive health in developing countries. For further details see Annex1 & 2.

For this study, we consulted about 85 water and sanitation professionals worldwide inviting information, case studies or data on personal/project/regional experience linked to the following:-

Perceptions around menstrual hygiene issues (adolescent girls/boys; women/ men)

Related social practices like seclusion, absenteeism, religious or social exclusion 

Absenteeism and drop-out linked to puberty, poor sanitation facilities, social mores

Impact on mobility, labour & productivity

Health related issues - rashes and infections; other

The availability and affordability of materials - cost, bio-degradables, ease of access & social acceptability. Kind of materials used - cloth rags, sanitary napkins, other

Hygiene issues linked to washing & drying of cloths, spaces for drying 

Issues related to disposal of used napkins, cloths

Was this issue ever articulated in your experience? If yes - please give details of circumstances; stimulus and context.

The overall objective of this paper is to compile a brief overview of initiatives in menstrual management as a precursor to action. We know that this review is not exhaustive in its scope and we look forward to adding more information and contacts to this stock take in the months ahead.


Very few professionals have actively engaged with the issue although it has crossed many a mind in passing.

Professionals from the Health or Water & Sanitation sector alike were astonished at the absence of this issue from both technical and rights based discourses, but unable in most cases to point us in the direction of substantive work on these issues.

The literature on Gender mainstreaming in the Water & Sanitation sector, is silent on Menstrual Management ­ adequacy of water for washing and bathing, availability of hygienic materials and solid waste management of disposables. Initiatives in this area are restricted to very small pilots, with poor follow-up and poor dissemination of results.

Although poor sanitation is correlated with absenteeism and drop-out of girls in developing countries, efforts in school sanitation to address this issue have ignored menstrual management in latrine design and construction. Wider aspects of the issue ­ such as privacy, water availability and awareness-raising amongst boys and men remain largely unexplored by development initiatives.

Hygiene promotion efforts have recently initiated a focus on this area but mainly on the software aspects i.e. telling girls and women about correct practices. These efforts do not currently target men and adolescent boys, nor do they systematically inform infrastructure design.

Minimal effort has gone into production and social marketing of low-cost napkins, reusable materials, research into bio-degradables, etc. Research and development efforts have been limited to commercial ventures that even today are unable to market products that are affordable for the poorest of the poor.

The issue of washing of soiled materials and environmentally friendly disposal of napkins is absent from waste management training, infrastructure design and impact evaluation.

In short, Menstrual Management is missing from the literature ­ whether it be manuals to sensitize engineers to gender needs or technical manuals on latrine designs, sanitation for secondary schools, solid waste issues ­composting, bio-degradable materials or even simple training modules for health and sanitary workers.

Our mailings generated immense interest in what would emerge pointing to a crying need to investigate the issue thoroughly, to articulate it clearly in relevant policy fora and to demonstrate viable practical solutions on the ground.


I was brought up in the city of Pune. My parents were quite unorthodox in their approach to menstruation and I did not have to endure exclusion from religious functions, or seclusion at home and elsewhere and so on during my periods. But I did face a major problem - attendance at school. It was about 7 km away from my home and commuting was not direct; hence I could not come home easily if I had a problem at school. The school was located in an area with very little ground water, and municipal water supply was also inadequate. As a result, on most days, all taps in the school, including those in the toilets, ran dry. I needed to change every 4 to 5 hours for about 3 to 4 days and hence I had to remain absent from school at the beginning of each period - which lasted for 9 or 10 days. One or two of my teachers were concerned about the gaps in my attendance and I distinctly remember two occasions on which I was asked why I remained absent so often. Unfortunately, I did not have the courage to broach the subject myself and I remained guiltily silent, as if I had no valid reason, and accepted the blame.

When I was in my late twenties, the municipal corporation arranged to send what is called a 'ghanta gaadi' (a mobile trash collection bin mounted on wheels and trundled along by an employee of the Sanitation Department), in the locality where we lived. One day in October, when I carried the trash from our home to the gaadi, the employee, who happened to be a middle-aged woman, told me not to trash any sanitary pads over the next 10 days, as it was the Navratri festival. She was worshipping the goddess and hence having to handle menstrual material would not be acceptable, she said. She had no qualms about handling any other kind of trash! After some deliberation, our family began make it a point to themselves deposit all trash in the large containers provided in each locality by the municipal corporation, thus avoiding passing on our 'dirty work' to others.

Real Life Case Study reported by Kalpavriksh, a Pune based NGO

On discussing this issue with senior specialists in the sector, reactions have ranged from the supportive to the downright sceptical. One senior sector specialist questioned the urgency and importance of addressing menstrual hygiene and management issues when there are so many other issues that need to be resolved first. The question we need to ask is ­ Whose priorities are driving project design and infrastructure investments today? Do these reflect and match what poor women and girls need and want ­ in their own right as individuals and also in their role of primary water and sanitation managers, mothers and health caregivers.

Across the developing world, the lack of appropriate and adequate sanitation facilities prevents girls from attending school, particularly when they are menstruating. Of the 113 million children currently not enrolled in school worldwide, 60% are girls. There is conclusive evidence that girls' attendance at school is increased through improved sanitation. Our survey of school sanitation yielded little apart from the above accepted wisdom on the reason for female drop-out. Investments in this sector, policy initiatives to scale up coverage and innovative pilots on improved toilets, have altogether failed to address this issue coherently. What is most disturbing is that the gender dimensions of the issue are well-articulated, without the corollary which would help to bring with it investment and action.

While menstrual hygiene is slowly creeping into the discourse and also the design of some awareness and behaviour change programmes, disposal remains a non-issue. We risk ignoring the disposal issue and links with solid waste and sewage systems at our own peril as is clear from the scale of the environmental problem this poses.


Men and women dispose of various items down the pit, such as condoms, plastic bags, sanitary towels and children's nappies. Such objects may cause blockages when pits are emptied and lead to pits filling more rapidly than needed. This O&M problem can best be solved through user education, rather than trying to design an engineering solution, although the engineer may then have to address household solid waste management. There may be cultural restrictions on disposing of sanitary towel waste.

Gender for Engineers, Work in progress, WEDC

In an average middle class woman's lifetime, she is likely to use 15,000 sanitary pads or tampons.

Over 12 BILLION pads and tampons are USED ONCE and disposed of annually, clogging our overburdened landfill sites.

An average woman throws away 125 to 150 Kgs of tampons, pads and applicators in her lifetime. The great majority of these end up in landfills, or as something the sewage treatment plants must deal with.

Plastic tampon applicators from sewage outfalls are one of the most common forms of trash on beaches. For building owners, pads and tampons that are flushed down the toilet are the most common cause of plumbing problems.

More than 2 billion sanitary items are flushed down toilets in the UK every year. These include tampons and sanitary pads, condoms, dental floss, cotton buds and even razorblades and syringes. When these items end up on the beach or along riverbanks they are called Sewage Related Debris (SRD) and in 2000 accounted for 6.5% of all waste collected during the annual MCS Beachwatch Survey.

Social marketing and social franchising have been successfully used in marketing of Oral Rehydration Salts and more recently for condoms, but these concepts have as yet to be extended to the distribution of affordable, environmentally friendly sanitary products for menstrual management. While women all over the developing world are constrained by the lack of facilities and unavailability of appropriate products to manage their menstrual needs, the problem is exacerbated in conflict torn or emergency situations.

Pages 2 - 3

See teaching girls in India to make washable pads (here, too) - Nineteenth-century Norwegian washable pads - Italian washable pad, probably from the 1890s

© 2004 Harry Finley. It is illegal to reproduce or distribute any of the work on this Web site in any manner or medium without written permission of the author. Please report suspected violations to