What’s the bleeding problem? Policy and attitudes towards sustainable menstrual hygiene materials in India

Rationale and objective: In a bid to improve menstrual hygiene outcomes in low- and middleincome countries, state and civic society stakeholders have determinedly promoted the take up of disposable or single-use pads, at the neglect of less polluting alternatives. This oversight is problematic as it contributes to the increased burden of waste management, and denies women the right to informed choice. Using an experimental approach, this study examines the effects of exposure to sustainable alternatives compared with single-use pads on women’s attitudes to menstrual materials and practices. We test the hypothesis that such exposure positively effects women’s preferences and attitudes to more sustainable alternatives versus single-use pads. Methods: 277 women across ten slums in Hyderabad, Telangana state, India, participated. Using stratified random sampling, women were offered single-use pads or reusable cloth-pads or only information on menstrual materials. Study was facilitated by local NGOs and all interactions were conducted by pairs of women. Women were interviewed before and after program participation about their menstrual practices and beliefs, awareness and preferences regarding menstrual materials. Analysis included Difference-in-Difference Ordinary LeastSquares Regressions and F-tests for equality among conditions. Results: Primarily, exposure to non-pad conditions (cloth and information) significantly improved preferences and attitude towards less polluting non-pad alternatives and disposal practices versus pad condition (Cohen’s d: 0.42 to 0.39; p