Dangers of Menstrual Cups in Poor Rural Communities

I am getting increasingly concerned about the pressure from the rich nations to get menstrual cups adopted among poor rural communities, especially in Africa.  A Danish company called “Makit ApS” was recently awarded a Swedish grant to promote their product, called “Ruby Cups,” in Kenya.

Women and girls in poor rural communities throughout the developing world have extremely limited access to clean water and soap.  These devices need to be washed thoroughly and frequently and properly in order to be used safely.  In our work, we have also found that menstrual cloths will be shared by women in the same family.  What would happen if they were sharing dirty menstrual cups?

The zeal of environmental activists, when it meets the greed of entrepreneurs in the West can be an overwhelming combination.  I wish a more critical perspective would emerge in the policy discussion around these products.

7 Comments

  • Linda,

    You are absolutely right. At Lunette, we also want to help women in developing countries and are brainstorming with a few women in Kenya about how to achieve this goal. These women have said menstrual cups are not the answer for all areas of Africa. It is not appropriate for the poorest of the poor for the reasons you mentioned. However, there are segments of the population where it would definitely be appropriate. We continue to search for the best way to offer help there.

  • All menstrual hygiene management options have drawbacks. Disposable products are costly and/or unavailable in addition to being hard to dispose of without adequate facilities. However, to say that reusable menstrual cloths are always automatically better than reusable menstrual cups isn’t necessarily always correct.

    Issues:

    1. Water use — Cups require less water in their use and cleaning.

    2. Drying and Storage — After a cloth pad has been washed it needs to be dried, without electricity. Best way – exposure to air and UV rays (i.e. outside either hung, or laid on a clean/dry surface). However it has been found that many girls/women are too embarrassed or ashamed to dry their cloth pads in public, and many store them unsafely (i.e. in close dark moist places, like under a mattress).

    3. Cup works solo — Pads require one to own and use underwear, or some other apparatus to hold a pad in place. Underwear use may be low, due to either traditional/cultural/accessibility reasons, in developing nations.

    4. Convenience — A menstrual cup typically has double the capacity of super absorbent pads and tampons. (I can attest to this – personal experience). That means a woman is making half the trips to the bathroom. The typical woman can go 8-12 hours between bathroom trips for menstrual management, that is a big improvement over typical products.

    The biggest drawback and barrier is cultural/religious and education barriers. Their barriers are more daunting, of course. That is why the Ruby Cup works education into their focus. So they start with educating women on their anatomy and bodily functions to de-stigmatize and empower them. They elicit and act upon feedback. The also use local female entrepreneurs to do direct sales to enable this, and overcome some cultural/religious/educational barriers.

    I don’t think this should be pushed on women in developing nations everywhere; I don’t think one option is suitable for women everywhere. But to blame water use and education seems a bit misguided. Whether one is going to use reusable cloth pads, or reusable menstrual cups, there is an education required on proper use, hygiene, cleaning, storage, and non-sharing, as well as water use and disposal concerns. Where organizations know there will be receptivity to all the options, they should educate on all the options.

    • I am hoping I didn’t come across as pig-headed or anything. I am stubborn, but I am not inflexible! 🙂 I have read the issues prior to posting my reply, and after that post I also came across another conservation you had in the comments with someone over cups. It is an issue requiring education and a multi-pronge approach.

      If a community has absolutely no access to safe water disposable products *might* seem to be best since they don’t need to be clean, but it potentially overlooks four issues – a) cost/availability of products (including the fact they need to be replenished regularly), b) education/availability for proper and safe disposal of used products, c) requires use of either belts/straps or underwear (another cost/availability issue), and d) the pressing fact that these people are likely drinking this unsafe water.

      There are likely cultural/religious barriers here as well, but I haven’t seen it well discussed – whether the cultural/religious barriers are not as high, or not talked about, I am uncertain. I have read of organizations working on low-cost disposable products, that strive to use locally available materials and provide local employment.

      If a community has a tightly constrained access to safe water cups *might* seem like the best option since they need the least amount of water to clean and do not need to be replenished regularly or require undergarments, but it overlooks three issues – a) cost/availability (even if only needed once the cost is high, and the fact that is often can’t be manufactured locally is an issue, as well as possible sharing), b) education/availability to properly use/clean the cup and dispose of menstrual waste, and c) sensitivity/respect for possible strong cultural/religious taboos that may prevent the use of internal menstrual products.

      I don’t know how women would share one cup if their cycles were at synchronized/overlapping, but that certainly isn’t always likely, and I concede there is certainly a possibility of sharing happening due to impoverishment, just as it does with cloth pads. Ruby-cup does have partners that provide other menstrual product options.

      If a community has reliable considerable access to safe water reusable cloth pads *might* seem like the best option since it simpler to use than cups, but doesn’t need to be replenished regularly like disposables, but that overlooks three issues – a) as always cost/availability (that may lead to sharing), b) sensitivity/respect for possible strong cultural/religious taboos that may prevent the proper washing, drying and/or storage of reusable cloth pads, and c) requires use of either belts/straps or underwear (another cost/availability issue). There are organizations working on either providing cloth pads or the means for women to make their own.

      So, what I was, perhaps indelicately, trying to point out before, is no matter what options are provided there are huge barriers. Cost/availability across the board. Proper sanitation on a community level for disposing of disposables or for water used for cleaning reusables. Proper sanitation for reusables on an individual level due to sharing (likely more due to cost/availability issues than to educational). Cultural/religious taboos that hamper the following. Proper sanitation for reusables on a individual level (embarrassment, shame or tradition leading to improper cleaning, drying or storage of menstrual products). Lack of adoption of internal products due to cultural/religious taboos. All of how women (and their roles, rights, menstruation, reproduction, etc) is viewed, discussed (or not) and handled, and how trying to education and change that comes up against long held cultural/religious beliefs/traditions/moors.

      So, to me, the big issue isn’t what type of menstrual hygiene management women in impoverished communities use. The big issues are clean safe water and adequate sanitation facilities. The cost/availability of pads/tampons/cups. The cultural/religious barriers that make it difficult a) to educate on, and follow the proper use, cleaning and storage of products to manage menstrual hygiene, and b) for girls/women to fully participate in their society.

      • Hi! So I’m really interested in this issue, particularly in crisis situations, such as in refugee camps. I’m disheartened to see Ruby Cup hasn’t released any data or information (hoping they will send some anecdotal info via email to me!!). There are so many variables! I’m glad you wrote on the topic. I worry greatly about what is the safest/most hygienic method for women in crisis situations in very low-resource settings and I’m not convinced by cups just yet, but mostly because I haven’t seen any good information that shows it is a success. I know even Diva Cup will not donate their product because it isn’t safe to use in low-resource settings. If anyone sees any more data on this please share here! I would love to see it!

  • Thank you for an insightful article! Safe menstruation is an issue, and you’re right that we don’t want interventions to inadvertently make situations worse. That said, I do wonder if you’re overestimating how dangerous menstrual cups really are.

    1. Like sex toys, silicone cups can be sterilized by boiling for ten minutes. Rather than saying “thou must not share cups,” it seems to me women should be educated about the risks of HIV and other blood-born disease, and how they can manage those risks.

    2. How much increased risk is there for inserting an object in the vagina which has been washed in the local drinking water, compared to drinking the water? For that matter, how does the risk compare to inserting a finger or penis recently washed in the water?

    3. You don’t need soap to clean a cup, only water (unless the holes are too small). When I go camping or use public toilet stalls, I clean my cup by urinating on it before reinserting. Fresh urine is not only clean, it’s sterile.

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