Menstrual Health

Ramya Arumilli and Anjali Katta



Menstrual Health is a widely under-discussed topic, especially in developing countries where menstruation is rarely considered a crucial part of healthcare. In reality, menstrual health and management are important, seeing as infertility and reproductive health issues may arise from unhygienic practices.

Legislation and policy is a key factor due to the inaccessibility of menstrual hygiene products in the United States and other developed and developing countries. Our project will be focusing on policies within the United States.

Many states within the U.S. tax pads and tampons, creating significant barriers to access. Schools, jails and prisons, workplaces, and public bathrooms do not account for the need for consistent, quality menstrual hygiene products, leading to unhygienic practices, hindrances to work and education, loss of confidence, and more.

In understanding the system of menstrual health internationally, we can piece together how numerous factors such as policy and legislation, economic feasibility, and environmental sustainability contribute to overall menstrual health.

Menstrual Cups: A Sustainable Solution to Unhygienic Practices in Rural Areas

Reusable menstrual cups are a relatively new product compared to traditional devices such as pads, tampons and simple cloths. Menstrual cups are typically made of medical grade silicone or latex and are inserting into the vagina during menstruation. They can be worn up to 12 hours per day, then washed and reworn. Menstrual cups can also be used for several years, making them a more sustainable option when compared to single-use pads and tampons.

In light of detrimental consequences from global warming and pollution, environmentally sustainable solutions such as menstrual cups are an excellent way to reduce waste product from menstruation. They are also a cleaner solution as they can be washed regularly, unlike a cloth which can lead to infections and diseases. In simple terms, there are many benefits to using cups in terms of the environment, sustainability, health, resources and economics. However, strong cultural beliefs and acceptance in rural areas are unpredictable and must be understood before tackling menstrual poverty with the solution of cups.

We talked to Camilla Wirseen, a founder and CEO of The Cup, an NGO working to improve menstrual and reproductive health through the distribution of menstrual cups in developing regions and education of students regarding menstruation and related concepts. Here are her answers to some questions we asked:

Why are menstrual cups a better alternative in the areas where you work?

How do girls and other menstruators use menstrual cups in rural areas?

How do you implement the use of menstrual cups in these regions?

Taking a look at data and research from an article about menstrual health education in India by WaterAid, an NGO focusing on clean water and hygiene, you can see that:

o "only 45% believe that menstruation is normal; and a vast majority observe socio-cultural, religious or food taboos during their period"

The strong cultural stigma around menstruation and practices create skepticism for the adaptation of menstrual cups into rural villages.

o “63 million girls are living in homes lacking toilet facilities.”

Fundamental infrastructures such as toilets need to be established before we can support the usage of menstrual cups because without the proper facilities to manage cups and clean them, an array of hygienic issues will appear.

o “National Family Health Survey 4, India’s DHS (2015-16), reported that only 42.4% of young women aged 15–24 are using unhygienic methods of protection during their period.”

A high number of menstruators still engage in unhygienic practices which may be resolved with a menstrual cup.

o “A systematic review on MHM in India found that… only 37% changed their absorbents in school”

A main benefit in exploring the utility of menstrual cups is the frequency in which the product should be changed. A cup can be used for up to 12 hours before being replaced, as opposed to 6-8 for pads or 4-8 for tampons, which resolves the discomfort of changing products while at school.

Throughout this project, we will explore the implementation of menstrual cups and their benefits, the barriers to implementation, environmental impacts, and health implications of current unhygienic practices through a series of interactive computer models, code that you can play with, and resources to learn more about this concept.

Menstrual Cups vs. Traditional Practices

A simple loopy model that shows the relationships between the stigmatization of periods and usage of hygienic products such as cups is shown on the left.

To play with this model and understand the relationship between these factors, click on the image's link.

These common beliefs, having a strong hold in religious and cultural practices, cause impoverished menstruators to continue their unhygienic menstrual rituals with dirty rags and cloths because of the overall unclean connotation tied to menstruation. Young girls that take part in accepting these beliefs of the community lay the stress of cultural norms upon themselves.

One such belief is "if we throw away the used pads in an open space and a snake sees it, it will become blind and we will become infertile" (Shah, 2013, pg. 214). These popular myths exacerbate the issue of menstrual poverty as they hinder progress towards the distribution of sanitary supplies such as pads or cups.

To read more about the traditional myths and beliefs and how they impact menstrual practices, visit this site.

Stella Model: Hypothetical and Ideal Implementation of Cups in a Small Village

Stella Online allows us to show certain mathematical relationships between variables.

This model demonstrates the implementation of menstrual cups in a small village. Setting the population limit to 500 people, the model represents how cultural practices may restrict a sudden surge of menstrual cups and how long it would take to fully implement menstrual cups in a village.

You can further explore the model and change variables and graphs to see how the exponential figure shown would change based on differing values.

Link to Model

Menstrual Products, Health, and the Environment

To play with this model and understand the relationship between these factors, click on the image's link.

Access to Medical Care and Infections

In developed countries, menstruators may be aware of alternate solution to managing their periods with pads, tampons, cups, and more, but in rural villages, an abundance of "traditional practices" such as rags, ash, leaves and newspapers are used while menstruating. This is extremely detrimental to the health and safety of adolescent menstruators who may face infertility later and older menstruators who may be prone to infections. Regardless of these health risks, many menstruators in remote areas do not have access to health care as they are often located 50 to 100 kilometres from the nearest hospitals. This interactive loopy model is a simple way to picture the relationship between cultural practices, the health of menstruators, and the effects on the environment.

Environment and Menstruation

Menstrual waste goes largely unconsidered when most of us think of pollution and landfill waste. However, in 2018 in the US alone, over 5.8 billion tampons were used (HomeStead), and that is exclusively tampons. Taking a broader glance at the world, as hygienic menstrual products are introduced to developing countries, sustainability should be considered.

Menstrual Health in Prisons


Federal inmates are provided menstrual hygiene products (pads and tampons in regular and maxi sizes) free of charge. However, the quality of these products is largely unknown and in all likelihood, inadequate.

In State Prisons

At the state and county levels, access to pads and tampons is limited. Inmates are provided pads as needed in Washington State prisons, however, the size (regular vs. maxi) is not regulated. Tampons may be purchased at commissaries (stores within prisons). These stores operate on a strict schedule, making it difficult to anticipate when one may need a product, especially in times of irregular menstruation. According to this survey regarding menstrual health in Missouri prisons, products provided by states are said to be ineffective, forcing menstruators to change their pad often or create makeshift pads and tampons using bedding, clothing, paper, and other materials available.

The findings include:

  • 87.3% of menstruating respondents use the free pads provided by MDOC (p. 12).

  • 50.0% of the women who use the free pads report needing to change the pads more frequently than every 30 minutes on days of heavy flow (p. 13).

  • 88.7% of menstruating respondents report having had a period accident in which they leaked blood onto their clothes, their bedding, or the prison floor (p. 13 – 14).

  • 80.3% of menstruating respondents use homemade tampons made in the prison (p. 12).

  • 84.6% of prison nurses and 88.2% of correctional case managers have heard that the incarcerated women use homemade tampons (p. 19, 20).

  • 46.2% of nurses agree or strongly agree that free tampons and better pads would improve incarcerated women’s mental health; 30.8% neither agree nor disagree (p. 19).

  • 22.5% of menstruating inmates report having had at least one vaginal infection in the past 6 months while in prison. Of those who have used homemade tampons, the self-reported incidence of infection is 28.1%. Of those who have not used homemade tampons, the self-reported incidence of infection is 0.0% (p. 17, 18).

  • 74.6% believe that receiving free tampons from MDOC would reduce their risk of vaginal infections, which suggests that the women have identified homemade tampons as a possible contributor to infections but continue using them anyway, due to lack of adequate alternatives (p. 17).

While a study based on prisons operated by the Missouri Department of Corrections is not directly transferable to those of Washington State, it can be assumed that products will not vary greatly from state to state, especially if they are provided to inmates free of charge. This data should give an indication of the need for sufficient (in quantity and quality) products in all correctional facilities.

Additionally, menstruators may need to prioritize purchasing of other personal care items such as deodorant, body wash, shampoo, etc. or medication such as aspirin or ibuprofen. Those in WA State facilities make between $0.70 and $2.70 per hour, severely restricting what they are able to buy. Due to the monopoly companies have over products sold at commissaries, products are typically overpriced and entirely unaffordable for prisoners without outside help. Many save this money to afford court fees. Furthermore, while state prisons provide free (but limited) on-site video calls, those in county prisons must pay up to $0.50 per minute to make a call; inmates may prefer spending their money on phone calls rather than personal hygiene products.

Other States

Thirteen U.S. states have passed legislation regarding menstrual hygiene products in state prisons. This includes Alabama, California, Colorado, Connecticut, D.C., Florida, Kentucky, Louisiana, Maryland, New York, Tennessee, Texas, and Virginia. However, as stated before, the products provided by the state are generally of poor quality and ineffective for imprisoned menstruators.

Interactive Loopy Model

To play with this model and understand the relationship between these factors, click on the image's link.

Menstrual Equity Legislation in Washington

July 2020 was the start of WA’s tax exemption on menstrual hygiene products. Senate Bill 5147 was passed in March 2020 during the 2019-20 legislative session despite COVID-19 budget cuts.

Senate Bill 6073, which aims to provide free menstrual hygiene products in all WA public schools, will be reintroduced during the 2020-21 legislative session. Find your WA State (legislative district) senator and representative using this site and contact them to show your support for this bill!

We used the background of the WA Department of Corrections Center for Women and its surrounding area to address the lack of access to menstrual hygiene in prisons, compare access to these products in a WA town as opposed to a village in India or a different developing country, and explain the impact single-use menstrual hygiene products have on the environment through the format of an interactive model.

Interactive Menstrual Waste and Economics Code: Jupyter and Python

This is an interactive code that allows you to input some data such as income and the type of menstrual products you and your family use to determine a few factors:

  • How much you approximately spend on a type of menstrual product per annum

  • Percent of your monthly income that you spend on menstrual health management

  • How much waste you produce using that type of product

This model will then further educate you on the menstrual cup and the reduction cost and waste that you would benefit from if you made the switch from single-use products to reusable ones.

You can download the latest python software here.

Or access Jupyter Notebook/ Download JupyterLab to run the code here.



This essay focuses on menstrual health--specifically menstrual poverty and its primary causes. If you are interested in learning more, take a look! The aim of the investigation is to determine the biggest factor in menstrual poverty in rural Indian villages.

Research Question: To what extent have traditional cultural norms and religious beliefs enforced menstrual poverty in rural Indian villages?

Extended Essay FINAL.docx


Access to menstrual hygiene products is restricted around the world, regardless of economic development, despite the importance of menstrual health for an individual's overall wellbeing. New legislation and policies can alleviate the burden of menstrual inequity. Additionally, sustainability and cultural factors must be taken into account when considering a solution to menstrual inequity.


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The content of these pages was created by students for students with the help of educators and scientists who were funded by National Science Foundation Award DBI-1565166. The views expressed herein are those of the authors and do not necessarily reflect the views of NSF or ISB.