It starts with a review of trends in the development of urban sanitation systems and then explores the interaction between menstrual management and sanitation systems, mainly relating to the issue of disposal of used menstrual blood absorption materials. Finally, it proposes a framework of interactions by positioning a range of issues of particular relevance for menstrual management into the different parts of the sanitation system.

In the framework (chapter 3), the most important menstrual management and sanitation system interactions from the perspective of the user occur at the toilet, where the facility conveniently serves (or not) the needs of the user, and to some extent conditions the behavior related to the disposal of used menstrual material. Further downstream, in the collection, conveyance and treatment parts of the system, the interactions relate mainly to the way menstrual waste has been disposed of and its potential to cause and contribute to blockages and the filling up of receptacles.

Generally, the appropriate disposal method for used menstrual pads and such material is with solid wastes that are collected separately from feces and urine. Where such arrangements are lacking or not used, menstrual waste may be inappropriately disposed of through sanitation facilities, which may lead to clogging or system failure. Understanding the interactions between menstrual management and sanitation is therefore important for improving sanitation functional access and ensuring benefits and sustainability of sanitation systems.

The review of interactions between sanitation systems and menstrual management (chapter 2) indicates that blockages are a real issue in the management of sewerage systems, and that menstrual products – particularly those composed of super-absorbent materials – contribute significantly to the problem. Relating to other systems, interactions are less clear, though non-degradable material may contribute to filling up of latrines and need to be manually removed for the use of excreta material in ecological sanitation systems.

It appears that information to the users is central for their behavior with regard to disposal of used menstrual materials. Still, in order to avoid absorption materials to be disposed of with feces, it is absolutely necessary to have bins or other receptacles available. Further, hand-washing facilities need to be situated within the toilet facility for menstruating women and girls to be able to handle menstrual hygiene. Still, menstrual management issues are rarely considered in the design of sanitation systems.

Looking towards future urban sanitation systems, one may assume that they need to save water, pollute less, and become more cost-effective. Looking at the general trends, however (chapter 1), we see an increased reliance on water-borne systems. In Latin America and China, these systems appear to be sewered, whereas in many parts of Asia an increasing proportion of the urban population relies on septic tanks. In Sub-Saharan Africa, however, traditional latrines mostly cater for the growing urban populations.

This review forms part of the Menstrual Management and Sanitation Systems research project financed by the Bill & Melinda Gates Foundation.

Download the project report (PDF: 5.37MB)