New study shows how culturally sensitive menstrual waste is burned and compromises urban sanitation infrastructure in Malawi and discusses consequences for public/environmental health

For the attention of: Solid waste management practitioners, Faecal sludge management practitioners, Menstrual health specialists

The problem: Throwing menstrual waste into urban pit latrines inhibits the development of pit emptying markets and faecal sludge composting ventures because it makes removing and treating the faecal sludge more difficult and expensive. As menstruation is often stigmatised, pit latrines are anecdotally known to be a popular disposal route due to their discretion. However, there is an absence of data to show the scale at which menstrual waste interacts with household toilet and waste facilities.

What we did and why: We surveyed 258 women in the southern African city of Blantyre, Malawi, on their menstrual absorbent use and disposal practices, along with their demographic characteristics and toilet and solid waste services. For those who were menstruating 10 years prior to the survey, they were asked what menstrual absorbents they used at that time.

What our study adds: The results show that disposable pads and menstrual cloth are the most commonly used menstrual absorbents, and almost all of these are either burned or thrown into pit latrines. Little menstrual waste goes into bins or rubbish pits due to privacy-related concerns about visibility of the waste. The results also suggest that the volume of waste is likely to grow in the future due to increased preference for disposable absorbents among younger generations.

Implications for city policy and practice: It is critical for public health that pit latrines in dense settlements are emptied when full. However, this remains difficult and expensive to do until either menstrual waste is diverted from pit latrines to culturally acceptable alternative destinations or pit-emptying and sludge treatment practices are designed to cope with the presence of menstrual waste in sludge. Supporting markets for high-quality reusable pads may reduce menstrual waste volumes, which are otherwise expected to grow.

For further information: 

The Menstrual Health Hub: This is a digital networking and knowledge platform to unites and strengthens the global menstrual community. The platform provides online space to connect with those working on menstrual and female health, and hosts free access to a database of relevant menstrual health resources around research, education, policy and innovation.

The Shit Flow Diagram initiative: A step towards providing adequate sanitation services in urban areas is to monitor the whole sanitation service chain, to identify its strengths and weaknesses. Shit Flow Diagrams can help achieve this by offering a new and innovative way to engage sanitation experts, political leaders and civil society in coordinated discussions about excreta management in their city.

Full research article: Blood flows: mapping journeys of menstrual waste in Blantyre, Malawi by Heather Roxburgh, Caron Magombo, Tamandani Kaliwo, Elizabeth A. Tilley, Kate Hampshire, David M. Oliver & Richard S. Quilliam.