An exploration of market organic sanitary products for improving menstrual health and environmental impact

Menstruation is defined as the cyclical bleeding process that occurs between menarche and menopause, which typically begins between 12 and 13 years of age (Kaur et al. 2018; Critchley et al. 2020). In binary gender terms, women comprise 49.5% of the world's population (The World Bank 2021). As such, at any given moment about 10% of the world's population is menstruating (Bull et al. 2019; Barrington et al. 2021). Menstruation is not defined by gender as transgender men, intersex and non-binary persons may menstruate and should therefore not be disregarded in menstrual health services (Bobel 2010; Frank 2020; Barrington et al. 2021). It is estimated that between 0.1% and 2% of the global population do not identify as cisgender (Spizzirri et al. 2021). Although menstruators understand how to manage menstruation sanitarily, which reduces the number of infections caused by poor Menstrual hygiene management (MHM) (Freidenfelds 2009), research shows that approximately 4.5 million American menstruators still suffer from menstrual health problems each year and that menstruation significantly disrupts their physical, mental, and social well-being of tens of millions of menstruators around the world (Critchley et al. 2020). It should be, however, noted that not all menstruators know how to manage their periods sanitarily. There are big gaps in knowledge when it is not taught in schools or by family members due to its taboo nature.

MHM differs drastically across the spatial landscape as the menstruating experience is influenced by culture, socioeconomic status, and individual health. For example, some cultures perceive menstruation as a natural, healthy process to be celebrated (Leena 2016; Chebii 2018) while others associate shame and impurity with the process (Sommer et al. 2015). Menstrual health, which includes the accessibility of menstrual products, accurate information on menstruation, and access to safe, hygienic bathroom facilities, is integral to MHM (Medina-Perucha et al. 2020). It should be noted that access to MH materials is a global problem and that inequalities exist between and within countries. Approximately 130-million menstruating minors are out of school due to inadequate MHM and approximately 500 million menstruators globally lack access to adequate facilities for MHM (The World Bank 2018; PMNCH 2020). In a study in an urban metropolitan city in Missouri, USA, 17% of high school students missed at least one day at school due to an inadequate supply of menstrual products, with significantly more 9th graders (33.3%) than 10th–12th graders (6.1%) (Kuhmann et al. 2020).

MHM may be overlooked as a health concern because of the seemingly accessible sanitary products and bathroom facilities. However, for a large number of menstruators in some low-income countries, the use of a pad or proper sanitary products is considered a luxury and is not common. Menstruators often resort to using available household items, like towels, clothing, or in some cases, plant materials. This lack of accessibility to sanitary products is termed ‘period poverty’ (Tull 2019; PMNCH 2020). Period poverty is linked with poor health outcomes. For example, one study found that in menstruators aged 15–24 years, more than one-third use unhygienic menstrual management such as clothes and anything else other than sanitary pads, locally prepared napkins, and tampons. These menstruators had significantly more symptoms of reproductive tract infections such as genital sore/ulcer (1.59 times more) and abnormal vaginal discharge (1.37 times more) than those who use hygienic methods during menstruation (Vishwakarma et al. 2021). Another study showed that 14.2% of college-attending menstruators in the US experienced period poverty with menstrual health products to meet their monthly needs and they reported severe mental depression (Cardoso et al. 2021). As such, the use of sanitary products is dependent on one's economic status and improper use of sanitary products or lack thereof can lead to major health issues (Das et al. 2015). To combat the lack of education and accessibility to menstrual products, there is a need for inexpensive, environmentally friendly, locally sourced, and culturally acceptable interventions. Economical menstrual pads made of locally available and ecological materials, such as banana, bamboo, aloe vera, papyrus, and water hyacinth fibers have been explored (Lee 2012; Kathirvel & Ramachandran 2014; Musaazi et al. 2015; Krishna et al. 2018).

We seek to explore and synthesize the current frugal methods to develop menstrual hygiene products with plant materials that are inexpensive, environmentally friendly, and easily accessible compared to plastic-based, commercial pads. The goal of this paper is to acknowledge unhygienic methods used to manage menstruation and explore the alternatives to reduce the environmental impact and health issues involved with the use of plastic-based menstrual products. In doing so, we aim to move the conversation of menstruation into the sustainability sector as menstruation is at the nexus of the three spheres of sustainability: economic, social, and environmental. For more technical aspects of the production and waste management of biodegradable, organic menstrual products, we recommend the readers review previous studies reported by Luchese et al. (2021) and Velasco Perez et al. (2021).

Commercial menstrual hygiene products, such as pads and tampons, are produced using methods from the 20th century. While these products have evolved to be flexible and absorptive for the active, modern-day menstruators, the ingredients of these products are likely hazardous for the human and environmental health (Soni et al. 2019). Menstrual products are classified in the US as medical devices, meaning that the ingredients of these products do not need to be disclosed to the public (WVE 2014). The proprietary nature of ingredients is highly problematic as the female reproductive system is extremely absorptive and sensitive, which allows for the chemicals to be quickly distributed to the blood stream and throughout the rest of the body (Scranton 2013; Lin et al. 2020). Research has been conducted on the link between endometriosis, cancer, reproductive organ damage, and pregnancy complications with plasticizers, volatile organic compounds, dioxins, furans, and synthetic fibers that are found in plastic-based menstrual pads (Table 1) (Weuve et al. 2010; Scranton 2013; Ferguson et al. 2019).

Table 1

Environmental and health effects of chemicals found in plastic-based menstrual hygiene products

Chemical Name (CAS #) [molecular weight] .	Chemical formula & structure .	Health effectsa .	Environmental fatea .	Toxicity (LD50)a,b .
Chloroform (67-66-3) [119.37]		Serious irritation Suspected of causing cancer Suspected of damaging an unborn child Causes damage to organs through prolonged or repeated exposure	Moderate soil mobility Non-biodegradable in soil	Oral, guinea pig; LD50 = 820 mg/kg Skin, rabbit; LD50 > 20 g/kg Oral, mouse; LD50 = 36 mg/kg
Chloromethane (74-87-3) [50.49]		Suspected of causing cancer Causes damage to organs through prolonged or repeated exposure	Not susceptible to photolysis Very high soil mobility Not readily biodegradable	Oral, rat; LD50 = 1800 mg/kg
Benzene (71-43-2) [78.11]		Serious eye and skin irritation May cause genetic defects May cause cancer Causes damage to organs through repeated or prolonged exposure	Very water soluble High soil mobility	Skin, guinea pig; LD50 > 9400 μL/kg Skin, mouse; LD50 = 4700 mg/kg Oral, rat; LD50 = 930 mg/kg
1,4-Dioxane (123-91-1) [88.11]		Serious irritation Respiratory irritation Suspected of causing cancer	Very high soil mobility Non-biodegradable	Oral, guinea pig; LD50 = 3150 mg/kg Oral, rabbit; LD50 = 2 g/kg Skin, rabbit; LD50 = 7600 μL/kg
Styrene (100-42-5) [104.15]		Causes serious skin and eye irritation Harmful if inhaled Suspected of damaging an unborn child Causes damage to organs after prolonged or repeated exposure	Not susceptible to photolysis Low soil mobility	Oral, mouse; LD50 = 316 mg/kg Oral, rat; LD50 = 2650 mg/kg Oral, mammal (species unspecified); LD50 > 1500 mg/kg
Di(2-ethylhexyl) Phthalate (117-81-7) [390.6]		May damage fertility May damage unborn child	No soil mobility rate	Skin, guinea pig; LD50 = 10 g/kg Oral, mouse; LD50 = 1500 mg/kg Skin, rabbit; LD50 = 25 g/kg
Di-n-butyl Phthalate (84-74-2) [278.34]		Suspected to cause damage to unborn child Suspected of damaging fertility	Low soil mobility rate Very toxic to aquatic life	Skin, rabbit; LD50 > 20 mL/kg Oral, guinea pig; LD50 = 10 g/kg Oral, mouse; LD50 = 3474 mg/kg
Tetrachlorodibenzo-p-dioxin (1746-01-6) [322.0]		• Fatal if swallowed • Cause serious eye irritation	No soil mobility rate Very high bioconcentration in aquatic organisms Prolonged environmental effects	Skin, rabbit; LD50 = 275 μg/kg Oral, rat; LD50 = 20 μg/kg Oral, mouse; LD50 = 114 μg/kg
Tetrachlorodibenzofuran (24478-72-6) [306.0]		Fatal if swallowed Fatal if in contact with skin Fatal if inhaled Suspected of damaging fertility or an unborn child	Very toxic to aquatic life Prolonged environmental effects	Oral, guinea pig; LD50 > 0.005 mg/kg Oral, rat; LD50 > 1.00 mg/kg Oral, mouse; LD50 > 6.00 mg/kg

Chemical Name (CAS #) [molecular weight] .	Chemical formula & structure .	Health effectsa .	Environmental fatea .	Toxicity (LD50)a,b .
Chloroform (67-66-3) [119.37]		Serious irritation Suspected of causing cancer Suspected of damaging an unborn child Causes damage to organs through prolonged or repeated exposure	Moderate soil mobility Non-biodegradable in soil	Oral, guinea pig; LD50 = 820 mg/kg Skin, rabbit; LD50 > 20 g/kg Oral, mouse; LD50 = 36 mg/kg
Chloromethane (74-87-3) [50.49]		Suspected of causing cancer Causes damage to organs through prolonged or repeated exposure	Not susceptible to photolysis Very high soil mobility Not readily biodegradable	Oral, rat; LD50 = 1800 mg/kg
Benzene (71-43-2) [78.11]		Serious eye and skin irritation May cause genetic defects May cause cancer Causes damage to organs through repeated or prolonged exposure	Very water soluble High soil mobility	Skin, guinea pig; LD50 > 9400 μL/kg Skin, mouse; LD50 = 4700 mg/kg Oral, rat; LD50 = 930 mg/kg
1,4-Dioxane (123-91-1) [88.11]		Serious irritation Respiratory irritation Suspected of causing cancer	Very high soil mobility Non-biodegradable	Oral, guinea pig; LD50 = 3150 mg/kg Oral, rabbit; LD50 = 2 g/kg Skin, rabbit; LD50 = 7600 μL/kg
Styrene (100-42-5) [104.15]		Causes serious skin and eye irritation Harmful if inhaled Suspected of damaging an unborn child Causes damage to organs after prolonged or repeated exposure	Not susceptible to photolysis Low soil mobility	Oral, mouse; LD50 = 316 mg/kg Oral, rat; LD50 = 2650 mg/kg Oral, mammal (species unspecified); LD50 > 1500 mg/kg
Di(2-ethylhexyl) Phthalate (117-81-7) [390.6]		May damage fertility May damage unborn child	No soil mobility rate	Skin, guinea pig; LD50 = 10 g/kg Oral, mouse; LD50 = 1500 mg/kg Skin, rabbit; LD50 = 25 g/kg
Di-n-butyl Phthalate (84-74-2) [278.34]		Suspected to cause damage to unborn child Suspected of damaging fertility	Low soil mobility rate Very toxic to aquatic life	Skin, rabbit; LD50 > 20 mL/kg Oral, guinea pig; LD50 = 10 g/kg Oral, mouse; LD50 = 3474 mg/kg
Tetrachlorodibenzo-p-dioxin (1746-01-6) [322.0]		• Fatal if swallowed • Cause serious eye irritation	No soil mobility rate Very high bioconcentration in aquatic organisms Prolonged environmental effects	Skin, rabbit; LD50 = 275 μg/kg Oral, rat; LD50 = 20 μg/kg Oral, mouse; LD50 = 114 μg/kg
Tetrachlorodibenzofuran (24478-72-6) [306.0]		Fatal if swallowed Fatal if in contact with skin Fatal if inhaled Suspected of damaging fertility or an unborn child	Very toxic to aquatic life Prolonged environmental effects	Oral, guinea pig; LD50 > 0.005 mg/kg Oral, rat; LD50 > 1.00 mg/kg Oral, mouse; LD50 > 6.00 mg/kg

^aInformation on health effects, environmental fate and toxicity (LD₅₀) were from NIH (2021), except for toxicity (LD₅₀) values of tetrachlorodibenzofuran which are from CDC (2021).

^bLD₅₀: the median lethal dose that is the amount of a test substance, given all at once, which causes the death of 50% of a group of test animals.

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Menstrual hygiene products made from polyethylene and polypropylene contain plasticizers, such as phthalates, to enhance the pliability of the product. During menstruation, the reproductive organ comes in direct contact with phthalate-containing pads and tampons. Therefore, significant absorption of phthalates (e.g., Di(2-ethylhexyl) Phthalate and Di-n-butyl Phthalate) into the female reproductive system is highly possible. In fact, many endocrine-disrupting health complications are associated with elevated exposure to phthalates, for example, precocious puberty (Kim et al. 2019), ovulation disorders (Weuve et al. 2010), and preterm birth (Ferguson et al. 2019).

Since menstrual products are not regulated, the high rates of volatile organic compounds (VOCs) detected in these products are very alarming (Kim et al. 2020). VOCs such as benzene, 1,4-dioxane, styrene, chloromethane, and chloroform have been detected in menstrual hygiene pads (WVE 2014). Specifically in menstrual pads, VOCs are typically added as adhesives, binders, and fragrances. Other products using VOCs include the manufacturing of car tires, the refining of petroleum, and nail polish remover (WVE 2014). Exposure to VOCs via dermal permeation during menstrual periods is of concern as multiple VOCs are known for reproductive effects, carcinogenicity, and damage to the liver and kidney (Lin et al. 2020).

The dioxins and furans such as tetrachlorodibenzo-p-dioxin (TCDDs) and tetrachlorodibenzofuran (TCDFs) are found in products that use chlorine-bleached materials (Shin & Ahn 2007). Since plastic-based pads contain these materials, exposure can cause the growth of uterine tissue on the outer areas of the uterus (i.e., endometriosis), cancer of the female reproductive system (i.e., endometrial cancer), and the abnormal growth of cells within or around the uterus muscle (i.e., uterine leiomyomata) (Shin & Ahn 2007; Weuve et al. 2010).

A synthetic fiber used in the production of plastic-based menstrual products to promote super absorbance is viscose rayon. Viscose rayon is made from wood pulp, which categorizes it as a natural regenerated polymer while still being a synthetic fiber because the wood pulp is treated with carbon disulfide to start the production of viscose (Shaikh et al. 2012). Viscose rayon is often mixed with cotton to produce a high level of absorbance. Viscose rayon was one of four synthetic fibers that were used in menstrual products. When companies started using these synthetic ingredients in pads, cases of menstrual toxic shock syndrome (MTSS) increased significantly and the use of these synthetic ingredients was banned, except for the use of viscose rayon (Nicole 2013). MTSS is known to be caused by a poison produced by Staphylococcus aureus bacteria. S. aureus are normally present without causing any harm in the vagina. However, when S. aureus are in an environment supportive of their rapid growth, they release superantigenic exotoxins that enter the bloodstream affecting the reproductive system, digestive system, muscular system, and the nervous system (Vostral 2018). The longer use of tampons or other intra-vaginal menstrual devices, the higher the risk of MTSS is (Billon et al. 2020), and synthetic fibers (e.g., polyester) provide a better environment for the growth of S. aureus than natural fibers (e.g., cotton). Furthermore, female workers in the viscose rayon industry have reported health issues regarding the female reproductive system such as menstruation disorders and spontaneous abortions (Koh & Chia 1994; Takebayashi et al. 1998; Wong et al. 2009; Sieja et al. 2018). What is more, the factory workers were exposed via dermal contact, i.e., the product was not on or near the reproductive area. Future research should examine the relations between the presence of viscose rayon in menstrual products and the harmful effects of some menstrual products throughout the duration of one's menstruating life cycle.

While we are not aware of any research stating that the level of these phthalates, VOCs, dioxins or furans, or viscose rayon are over the toxic health guidelines, the continuous exposure to these toxins can lead to many health issues and even result in death (Scranton 2013). Many menstruators across North America are becoming aware of the health hazards and demanding that menstrual products are no longer considered medical devices so that all the ingredients of these products are explicitly stated on their packaging (WVE 2014). The harmful ingredients detected in plastic-based pads and the associated health issues affect not only the human body but also the environment.

One of the major impacts that plastic-based pads have on the environment is the residual waste resulting from the disposal of the product. For example, about 12,000 single-use products are used throughout one individual's reproductive years; each product may take up to 800 years to biodegrade (Soni et al. 2019). In other words, on average, menstruation occurs for about 40 years in a lifetime, bleeding for 3–7 days a month or about 6.5 years of period. A single menstruator is estimated to use between 5,000 and 15,000 pads and tampons in their menstrual life cycle (Borunda 2019). In the US alone, approximately 12 billion pads and 7 million tampons are discarded annually (Dillon 2017). As are other solid wastes, most used pads and tampons are disposed of in trash receptacles and end up in landfills, while others find their way to reach the marine environment. Plastic-based pads are composed of up to 90% plastic or non-degradable materials, such as pad wrappers, adhesive strips, and so on, so that they take up to 500 years to fully break down in a landfill (Barr 2018). By replacing plastic-based commercial pads with a biodegradable alternative, the 500 years it takes for plastic-based pads to degrade could be reduced to 5 weeks. Other negative impacts that plastic-based pads have on the environment are petroleum-derived synthetic materials in the production of the pads and emissions during material acquisition, processing, packaging, and distribution (Hait & Powers 2019).

Used menstrual pads are disposed of in several different ways depending on sociocultural norms and taboos related to menstruation (Elledge et al. 2018). The less biodegradable waste generated from single-use feminine hygiene products (FHPs) is sent to landfills, clogs sewage pipes, and/or is thrown out into open fields every day (Kaur et al. 2018; Soni et al. 2019). As plastic-based pads degrade, the microplastics, fragmentation, and degradation of plastic materials, within the product enter the environment during landfill disposal or can infiltrate water streams if single-use FHPs are not disposed of properly. After the disposal of plastic-based pads in either the marine environment or a landfill, they begin to degrade into microplastics. The occurrence of microplastics (<5 mm) in the water is a significant threat to human health (Rahman et al. 2021) and aquatic ecosystems (Rezania et al. 2018). The occurrence that humans have with microplastics is larger than one might expect. Humans are typically exposed to microplastics through ingestion, inhalation, and dermal contact which may cause oxidative stress, cytotoxicity, altering metabolism, immunity disruption, translocation to distant organs, neurotoxicity, reproductive toxicity, and carcinogenicity (Rahman et al. 2021). The ingested microplastics bioaccumulate in aquatic biota and may cause negative impacts on growth and development (Rezania et al. 2018). For example, larval and juvenile sea snail showed a delayed growth due to exposure to high microplastic concentrations, although an insignificant effect was found at environmental concentrations (Lo & Chan 2018). Ingested microplastics have shown lethal or sublethal effects on marine organisms as they can serve as a vector of toxic chemicals (Rodrigues et al. 2018). These products pollute the environment, thereby indirectly impacting human and nonhuman health (Grose & Grabe 2014) and a fully biodegradable alternative could ameliorate these issues (Tudu 2019; Achuthan et al. 2021).

The biodegradation of organic products takes less time than plastic-based products, making organic products a more ecologically sound option (Kaur et al. 2018). A biodegradable sanitary pad disposed through a green waste stream would be composted. Composting, the breaking down of organic matter into a usable and commodifiable product, is an important part of circular waste management (Rynk et al. 1992) that can eliminate harmful pathogens while simultaneously generating a highly useful product for agricultural use (Sikora 1998).

The Water, Sanitation, and Hygiene (WASH) sector focuses on Sustainable Development Goal 6 which aims to provide clean water, proper hygienic methods (including MHM), and sanitary areas for civilians to clean themselves (United Nations 2021). As waste management facilities are not readily available globally, the structure of one's built environment influences the menstruation experience. Shoemaker (2008) described how rural people living in the riparian environments often toss menstrual waste directly into streams, which contaminate them with pathogenic microbes. Those experiencing homelessness in urban centers like New York City, USA, lack sanitary disposal access (Sommer et al. 2020; Barrington et al. 2021). Chebii (2018) and Ngugi & Nyaura (2014) detailed the indelible and complex relationship between the built environment and menstruation experiences in a Kenyan case study. As economic inequality produced a slum and squatter settlement, the lack of sanitation disproportionally affected young girls. As their families struggle to attain basic needs, menstrual products and privacy are non-existent. Alternatively, the at-home living environment may offer a respite to some young girls in South Asia who often missed school as their educational facilities lacked disposal systems, proper privacy measures, and water supply (Mahon & Fernandes 2010).

The aforementioned examples deal with the infrastructural failures of society, but culture folklore also produces tangible social and environmental consequences. Menstruation has been associated with ‘black magic’ as well as witchcraft (Sommer et al. 2013). A striking example is reported by Umeora & Egwuatu (2008). In rural Nigeria, according to the folklore, if menstrual waste is not buried, witches would seek out the blood. And if blood is found, the woman would become infertile and therefore deemed ‘destroyed’. The folklore can affect the environment depending as any menstrual products containing synthetic fiber rayon or organochlorines will disturb the soil microflora when buried (Kroesa 1990). Furthermore, human health is at risk if the disposer was infected with a virus like hepatitis or HIV; these viruses retain infectivity and may live up to 6 months in soil (Shoemaker 2008). To that end, improved waste management techniques would also require addressing sociocultural misconceptions. Until then, providing a biodegradable alternative to single-use menstrual pads will decrease the amount of solid waste generated and will also give menstruators a cheaper alternative to expensive FHPs on the market.

Plastic-based pads have been used for decades and their disposal has caused great environmental harm and created a market for more eco-friendly options. Not only do organic menstrual pads help with environmental conservation, they also are more easily accessible in rural areas and low-income countries. As such, plant-based products with locally sourced materials help alleviate some of the health issues involved with unsanitary methods often used due to the price, inaccessibility, and sociocultural barriers to MHM. We define plastic-based menstrual products as menstrual products that are not made with organic products and/or contain chemicals to make the product more esthetic, comfortable, or to lower production/manufacturing costs. We acknowledge that plant-based pads as opposed to plastic-based pads also have plastic components, such as wrappers, backing, adhesive strips, and so on, even though the main absorbance layer is made of natural materials.

Table 2 offers examples of organic pads. While the plant-based, organic pad products presented here are not meant to be exhaustive, we seek to explore suitable plant materials that can be locally harvested and manufactured at a low cost. We explore water hyacinth, bamboo, banana stems, papyrus, cotton, and hemp. Natural plant fibers are cellulose-based and attract liquids which make them highly absorbent (Table 3). For example, cotton fibers can hold water about 25 times their own weight (Dochia et al. 2012). Each organic pad has a different focus depending on the salient issue(s) companies seek to address. The intentions of the product can vary between emphasis on addressing social issues, such as absenteeism from work and school, environmental issues, due to the large number of disposable pads that take decades to degrade, or economic issues, with the inaccessibility to use hygienic menstrual methods because of how expensive plastic-based pads are in their area. As these issues are interconnected and non-mutually exclusive, all companies work towards a common goal: an affordable, sanitary, eco-friendly alternative to plastic-based pads.

Water hyacinth is a floating aquatic plant that is invasive to many regions. This plant grows very quickly, with a doubling period of approximately 2 weeks, and reproduces asexually, generating daughter plants, where the root systems are connected through stolons. As such, water hyacinth can create floating barricades in the water that inhibit the environment they are growing in. The water hyacinth, when grown in multitudes, can disrupt aquatic life by reducing oxygen levels in the water and taking over the native plant species' habitat. Not only does the water hyacinth disrupt aquatic life, but it also limits, if not eliminates, the recreational use of the body of water (McVea & Boyd 1975; Masifwa et al. 2001; Toft et al. 2003).

Water hyacinth fibers have been utilized in the production of polymer composites (Abral et al. 2014), livestock feed (Lu et al. 2008), wastewater treatment (Qin et al. 2020), and sanitary applications (Musaazi et al. 2015). Water hyacinth is a suitable alternative to plastic-based pads because it is cellulose-based, biodegradable, and does not harm the human body. In addition, it is a fast-growing invasive species that causes environmental problems if not managed properly.

Bamboo is native to many Asian countries and its adaptability allows growth in many different climates. Bamboo is used in many different industries of textiles, erosion control, and construction because of its rapid growth rate of 3–4 years (Erdumlu & Ozipek 2008). With rapid growth, bamboo can become invasive and cause damage to the native fauna and flora. As a result of this, the health of native species declines due to the lack of nutrients they are receiving.

The high absorption rate, antibacterial properties, and biodegradability make bamboo a healthy and environmentally friendly alternative to plastic-based, commercial pads (Rathod & Kolhatkar 2014). By utilizing bamboo in the production of organic pads, it decreases the cost of materials and is less harmful to the environment than plastic-based commercial pads.

Banana trees are native to the tropical areas in the eastern hemisphere. In Sri Lanka, over 123,000 acres of land is devoted to the cultivation of bananas and the annual production rate is approximately 20 tons per acre (Kudagamage et al. 2002). With high banana production rates, the disposal of the stems after cultivation is challenging. As such, companies like BanaPads (Table 2) have endeavored to create a ‘frugal development’ that manages banana tree waste by making organic pads.

Papyrus is an aquatic plant that is also known as paper reed, which is native to Africa. The plant and its cellulosic fiber have been used for centuries in different applications, such as ancient Grecian documents, wastewater treatment, shoe soles, menstrual products, and constructed wetlands (Alexopoulou et al. 2013; Mburu et al. 2015; Musaazi et al. 2015; Abou-Elela et al. 2017; Bemerw et al. 2021). In fact, Egyptian menstruators used tampons made of papyrus in the 15th century B.C. (Weissfeld 2010). Furthermore, papyrus has been utilized as a component for menstrual pads in rural Africa where the plant grows abundantly and accessibility to menstrual products is limited.

Cotton is native to tropical and subtropical parts of the world and is now cultivated in various regions around the world. Cotton has been used in many industries, most notably in the textile industry. Cotton fibers are absorbent, durable, and soft, which makes them the prime material used for items, such as towels, hygiene products, and many household items. Because of the high absorbency and successful cultivation, cotton is easily accessible and highly diverse. Using pure, organic cotton for menstrual products is likely to not cause health issues and allows the menstrual pad to be more biodegradable compared to plastic-based pads.

The global organic sanitary pads market is expected to increase by USD 901.71 million from 2021 to 2026 (Technavio 2022). This increase is mainly attributed to a growing population of working women, growing awareness about female hygiene and environmental impact, and increasing health issues related to plastic-based pads (Peberdy et al. 2019; IMARC 2021). This section details products that are made predominately with plant materials and offers brief examples of how companies are working at the nexus of sustainability and menstruation.

The Lilypad and Janipad are examples of organic menstrual products using predominately water hyacinth. The Lilypad is a menstrual pad that is made from water hyacinth and agricultural waste such as wood and bamboo (Lockley et al. 2014). With origins in Uganda, this biodegradable pad was created to address the lack of education and sanitary practices. As water hyacinth grows in abundance and is therefore easily accessible in this region, the manufacturing costs of this pad are very low. Lilypad sells in Uganda for the market price of $1 USD for a pack of 10 pads. Demand for products results in a demand for workers. As the popularity of products such as Lilypad rises, more workers will need to be employed to keep pace with product demand. Increased demand for handmade products has allowed women in the area to become employed in an industry that expands economic opportunities for women.

Created from water hyacinths in Kenya, the Janipad decomposes within months (MAPPINGDW 2013). Lake Victoria has a plethora of water hyacinths that have hindered the recreational use of some parts of the lake and disrupted the native flora and fauna. Therefore, creating a sanitary pad from an abundant material minimizes the cost of products needed to create the pad and benefits the habitat by allowing the native species to grow instead of the water hyacinth. Janipad addresses the social and environmental issues that pertain to menstruation, namely school absenteeism and generation of plastic waste. On average, over half of young menstruators miss school for the duration of their cycle (BRIDGE 2015) and reducing the number of missed school days is of the utmost importance for young menstruators' long-term well-being. Research shows an accumulation of missed school days often results in girls completely abandoning their education, which increases the likelihood of child brides (BRIDGE 2015; Yilmaz et al. 2021).

Banana stems from banana trees are widely available as agricultural waste. Multiple companies recognized an opportunity to recover the perceived waste and produce a sustainable solution to menstruation in low-income countries. For example, the Go! Pad, created by Sustainable Earth Enterprises (SHE) utilizes locally sourced banana plants to lower production costs and increase accessibility. Since banana fibers have such high absorbency qualities, SHE taught local banana farmers to properly cultivate the stems and unwanted materials from the plant for SHE to purchase for use in the production of the Go! Pads. Moreover, SHE works to increase the accessibility of menstrual hygiene products to menstruators in Rwanda where many young menstruators must miss school and work because they do not have the means to properly address menstruation (SHE 2021). The lack of employment for women in this region is caused by their absence from work due to menstruation. SHE offers jobs to women, giving them an opportunity to work and learn about proper hygienic menstruation methods, and access to affordable, safe methods for managing menstruation.

BanaPads is a company that was founded in Uganda with the purpose of improving menstrual hygiene methods in the country (Roddenberry Foundation 2022). By tackling this social issue, this company also wanted to create an environmentally friendly, biodegradable pad that utilized the excess waste material from banana plants. The banana fibers are dried and combined with paper materials and an enzyme, which creates an absorbent pad. This company helps menstruators to become more educated on healthy MHM. Furthermore, BanaPads offers menstruators an opportunity to individually practice safer MHM while also enabling them to generate a form of secondary income. Since these pads are sold by menstruators and to people that they know, a network marketing business model helps expand accessibility to menstrual products and increase menstruation knowledge.

Saathi, creators of the Saathi Pad, uses locally sourced banana and bamboo fibers (Saathi 2021). While this pad was created in Gujarat, India, it is available to menstruators around the world to purchase. Because the sole components of these pads are plant-based, they are biodegradable and chemical free, which mitigates the environmental and health issues that plastic-based pads pose. The Saathi Pad not only increases the availability of pads for menstruators in India but also creates an environment of menstrual education for those who purchase a Saathi pad. Saathi also employs women to increase gender equality, which induces a social and economic change in the culture of this region. By purchasing materials from local farmers and selling pads at $1.62 USD, Saathi strengthens the local economy and makes affordable sanitary pads available in the region.

Finally, the Safe Pad is a reusable, biodegradable pad that was created by Sanfe to address the social and environmental issues regarding menstruation and proper menstrual hygiene (Barrett 2019). Created from banana fibers, polyester piling, and cotton polyurethane laminate, the reusable pad helps menstruators in India use proper sanitary methods. The use of banana fibers in the production of the Safe Pad helps to lower the production and market cost of the pads ($2.68 USD), making the pad more affordable for menstruators in India. However, it should be noted that polyester (polyethylene terephthalate) used in the Safe Pad is a petroleum-derived artificial polymer.

Papyrus, cotton, and hemp are utilized to create cleaner and safer menstruation products. One example is the MakaPads, produced from papyrus and wastepaper. Developed in Uganda, the MakaPads emerged in a region where many menstruators cannot or do not attend school due to unhygienic or improper menstrual management (Musaazi et al. 2015) as they do not have the accessibility to inexpensive, sanitary methods to manage their menstruation. In Uganda, papyrus is a native plant and is abundant. This pad is often provided free of charge or sold at a very low price ($0.60–0.68 USD for 10 pads) to increase accessibility. By doing so, the MakaPads have addressed the economic issue that is a major factor in menstrual hygiene in the region.

Aisle, previously called Lunapads, is a Canadian company that creates reusable menstrual undergarments and the Aisle Pads (Aisle 2021). The company aims to offer menstruators a way to use menstrual products hygienically while minimizing the waste produced from disposable menstrual products. The pads are made from various plant materials that include: (1) Tencel, a fiber from wood sources that helps develop the yarn for absorbency in these pads and undergarments; (2) Organic cotton grown without any chemicals to decrease exposure to harmful chemicals that are often in menstrual products; and (3) Technical cotton created from absorbent and water repelling yarn to improve the performance of pads (Aisle 2021). These pads range from $16 to $22 USD, dependent on the absorbency of the reusable pad.

PadBack is a company originating in South Korea that created a biodegradable box that contains materials to make pads in a user-friendly manner (Arkarsu 2013). PadBack aims to overcome social issues associated with menstruators who do not have accessibility to feminine products made of agricultural fibers like papyrus, cotton, and hemp. Once used, a PadBack can be disposed of in soil where it can serve as a fertilizer to help the plants grow.

Menstruation is a biological process that nearly half of the global population experiences, which is steeped with misconceptions about cleanliness, causing alienation and health risks. What is more, menstruation could be addressed at the crux of the sustainability movement. The social, economic, and environmental constraints offer opportunities to improve sustainability practice on multiple fronts, including equity. Here, we offer an overview of alternative organic menstrual products that alleviate health issues, social sigma, and economic inequality. Due to the health and environmental effects of plastic-based products, the use of organic products should be more commonplace in our global society. The Lilypad, Janipad, Saathi Pad, Safe Pad, Go! pad, BanaPads, MakaPad, Aisle Pads, and PadBack are some of the organic menstrual products that have been proven to work and satisfy the needs regarding MHM. These brands of pads demonstrate how the production of organic pads can play a potential role in environmental conservation and allow menstrual products to be more accessible to menstruators who have challenges practicing sanitary methods. Unfortunately, the ingredients in most plastic-based products are not disclosed, although the consequences for health have been demonstrated through research. While some negative health effects can be attributed to the misuse of menstrual products, other effects are solely due to the chemicals used in the products that the menstruators place in sensitive, absorbent parts of their bodies. An affordable, accessible, and chemical-free menstrual product is a necessity for gender equity and the global sustainability movement. Since menstrual products are commonly used every month by menstruators including women from early teens to around 50 years old, the amount of used menstrual products sent to landfills is of concern. Biodegradable, organic products have the potential to create better health and economic outcomes for menstruators across the globe and reduce the environmental footprint.

This study was financially supported, in part, by the Texas State Houston-Louis Stokes STEM Pathways and Research Alliance (H-LSAMP) scholarship (Grant #: 1911310) awarded to Jamie Hand and by the start-up fund from the Texas State University to Sangchul Hwang. The authors would also like to thank the National Science Foundation (Grant #: 1829144) for funding.

All relevant data are included in the paper or its Supplementary Information.

The authors declare there is no conflict.