# Addressing period poverty through sustainable solid waste management practices in the Indian Himalayas: A qualitative study

Cannon Hansen, Tanner Frahm, Meredith Luczak, Chering Norbu, Ishita

Khanna, Tejinder P Singh, Manoj Sharma

► To cite this version:

Cannon Hansen, Tanner Frahm, Meredith Luczak, Chering Norbu, Ishita Khanna, et al. Addressing period poverty through sustainable solid waste management practices in the Indian Himalayas: A qualitative study. Advances in Medicine, Psychology, and Public Health, 2025, 2 (4), pp.215-224. 10.5281/zenodo.14139663. hal-04859286

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Original Article in Public Health

# Addressing period poverty through sustainable solid waste management practices in the Indian Himalayas: A qualitative study

Cannon HANSEN<fnref n="1" />*, Tanner FRAHM<fnref n="2" />, Meredith LUCZAK<fnref n="3" />, Chering NORBU<fnref n="4" />, Ishita KHANNA<fnref n="5" />, Tejinder P. SINGH<fnref n="6" />, Manoj SHARMA<fnref n="7" />

Cite this paper as: Hansen C, Frahm T, Luczak M, Norbu C, Khanna I, Singh TP, Sharma M. Addressing period poverty through sustainable solid waste management practices in the Indian Himalayas: A qualitative study. Adv Med Psychol Public Health. 2025;2(4):215-224.

Doi 10.5281/zenodo.14139663.

Received: 19 July 2024

Revised: 20 September 2024

Accepted: 25 October 2024

Published Online: 11 November 2024

## Abstract

**Background:** Period poverty and inadequate menstrual hygiene management (MHM) significantly impact the lives of menstruating individuals globally, contributing to inequalities such as school absenteeism and reproductive health issues. Although initiatives have focused on improving access to menstrual products and education, the sustainability of menstrual waste management remains underexplored, particularly in ecologically sensitive regions like the high Himalayas.

**Objectives:** To investigate the current practices of menstrual product disposal in the Spiti Valley district of Lahaul and Spiti, India, and to implement sustainable interventions to address improper waste management.

**Methods:** This study employed semi-structured interviews with 27 menstruating individuals from three villages in Spiti Valley, followed by a train-the-trainer educational program. Data were collected on prevalent disposal methods and interventions were introduced, including a waste segregation system and a compost pit for biodegradable menstrual products.

**Results:** The study found that common disposal methods included random dumping, shallow burying, and open pit burning, which pose significant risks to human health and the environment. Preliminary feedback indicated that the implemented interventions were well-received, but their long-term success depends on sustained community engagement and monitoring.

<footnote n="1">¹University of Utah, Department of Biomedical Engineering, Salt Lake City, USA. E-mail: u1148012@utah.edu ORCID: 0009-0005-3173-7528</footnote>

<footnote n="2">²University of Utah, Department of Biomedical Engineering, Salt Lake City, USA. E-mail: u1117978@utah.edu ORCID: 0009-0002-8558-2953</footnote>

<footnote n="3">³University of Utah, School of Medicine, Salt Lake City, USA. E-mail: merri.luczak@hsc.utah.edu</footnote>

<footnote n="4">⁴Spiti Eosphere, Kaza Khas Spiti, India. E-mail: norbu@spitiecosphere.com</footnote>

<footnote n="5">⁵Spiti Eosphere, Kaza Khas Spiti, India. E-mail: ishita@spitiecoshpere.com</footnote>

<footnote n="6">⁶University of Utah, School of Medicine, Division of Public Health, Salt Lake City, USA. E-mail: tp.singb@utah.edu ORCID: 0000-0002-9244-2177</footnote>

<footnote n="7">⁷University of Nevada, Las Vegas, School of Public Health, Department of Social & Behavioral Health, Las Vegas, USA. E-mail: manoj.sharma@unlv.edu ORCID: 0000-0002-4624-2414</footnote>

<footnote>*Correspondence</footnote>
**Conclusions:** The findings underscore the urgent need for sustainable menstrual waste management practices in the high Himalayas. These practices align with multiple Sustainable Development Goals (SDGs), such as gender equality, clean water and sanitation, and climate action. This study highlights the intersection of period poverty, sustainability, and public health in a fragile ecosystem, emphasizing the importance of community involvement for long-term success.

**Take-Home Message:** Sustainable menstrual waste management is crucial for addressing period poverty and protecting public health in ecologically fragile regions like the Himalayas. Community-driven interventions, such as waste segregation systems and compost pits, can mitigate environmental and health risks but require sustained community engagement to ensure long-term success and the achievement of Sustainable Development Goals.

**Keywords:** Community-led interventions; ecological impact; high Himalayas; menstrual hygiene management; sustainable development.

## INTRODUCTION

Period poverty and poor menstrual hygiene management (MHM) affect millions of people worldwide and have caused vast inequalities such as higher rates of school absenteeism and reproductive tract infections among those who menstruate [1,2]. Contemporary projects have sought to alleviate period poverty and empower women by improving menstrual education and access to period products. Promising global trends of increased hygiene and product accessibility such as education, awareness, behavior change, training, societal support, and distribution demonstrate the projects' success in alleviating period poverty and motivating future similar ventures. An extensive midway analysis of the “MHM in Ten” Agenda showed global improvements in all five of its priorities [3]. Their priorities were geared toward educating girls about menstruation and providing more accessible and hygienic menstruation management by 2024.

One area of period poverty that has often been neglected is sustainability, particularly with the solid waste management of used menstrual products [4]. With an average of 459 periods over a lifetime, a menstruator will generate up to 150 kg of sanitary waste [5]. Heightened MHM awareness has made plastic sanitary napkins an aspirational product in countries like India; however, the increased use without proper disposal techniques has made the product a major contributor to unsustainable waste [6]. India is estimated to dispose of 12.3 billion pads a year (93% of which are plastic sanitary pads), resulting in 113,000 tons of menstrual hygiene waste [5]. The increased use of sanitary napkins has shown improved hygiene in some studies [7] but when improperly disposed can take 500-800 years to biodegrade and cause additional health challenges [8]. An improper waste management system such as open dumping or burning can lead to stress for menstruators, contamination of water and agriculture, and the destruction of fertile lands and fragile ecosystems [7, 9–11]. These challenges are compounded in regions like the high Himalayas because of its arid desert ecosystem and close winter living quarters [12–14]. Improving solid waste management of menstrual products (SW-MHM) in the high Himalayas is therefore vital for preserving communal public health, limited agricultural fertility, and the fragile ecosystem. SW-MHM projects address multiple sustainable development goals (SDG) including SDGs 1,3-6, and 10-13 when projects involve SW-MHM policy implementation.

Current solid waste practices and disposal behaviors for menstrual products are unknown in many regions of the world. Without this data, it is difficult to implement programs and policy changes that appropriately address SDGs. Additionally, a recent review evaluating the extent of global women's empowerment indicated that while many sanitation projects aimed to empower women, the extent of females' empowerment was limited due to poor definitions and project conceptualization
[15]. In this study, we aimed to better understand waste practices and disposal behavior in the high Himalayan Spiti Valley, district of Lahaul and Spiti, India, and establish a clear definition for empowering women in the community by aiming to improve the SW-MHM technology and education. We implemented a three-pronged approach that included semi-structured interviews of menstruating village members, a train-the-trainer education model, and the introduction of waste segregation and compost interventions. Increasing the sustainability of SW-MHM in the high Himalayas is an urgent and neglected need that addresses SDGs, empowers women, and improves human and environmental health and well-being.

## METHODS

A descriptive interview-based study of SW-MHM was conducted with twenty-seven adult menstruating women (N=27) from three villages in the Himalayan Spiti Valley, district of Lahaul and Spiti, India followed by interventions. Convenience sampling was used to interview participants in the villages of Demul, Langza, and the Pangmo Nunnery using a semi-structured questionnaire. This study was conducted in accordance with the Declaration of Helsinki and followed a protocol approved by the University of Utah Institutional Review Board (Protocol Number: IRB_00154758, Date: 26 April 2023). Following the conclusion of the interview, training on menstrual hygiene product disposal was provided to the same participants. A train-the-trainer approach was adopted, and participants were encouraged to train other members of their village community. Evidence-based interventions of model waste management systems were demonstrated in two of the villages from the study area. A workflow of the study methods is shown in Figure 1.

<figure><img src="image_3.png" /><figcaption>**Figure 1.** Workflow of methods.</figcaption></figure>

### Interview

Participants were chosen based on convenience sampling under the condition that each participant was a menstruating adult. The Pangmo Nunnery had 18 participants (n = 18), Langza had 4 (n=4) and Demul had 5 (n=5) totaling 27 participants (N=27). As the first group was all from a nunnery, all 18 participants were nuns. The participants from the two other villages were menstruating community members. Before each participant's interview a translator was selected to ensure proper
comprehension of the questions and a consent form was signed allowing for informed consent to be obtained for all subjects involved in the study.

The questions in the interview included:

1. What type of product do you normally use during your period?

2. How do you dispose of that product after use?

3. If you use a cloth pad,

a. Where do you obtain it?

b. How/do you clean it?

c. How often do you change it?

4. If you use a commercial pad,

a. Where do you obtain it?

b. How often do you change it?

## Training

Following the survey, training was conducted in each village. The training followed a train-the-trainer model and focused on teaching principles to share the training information with other community members. Participants were first trained in menstrual hygiene as part of another study (unpublished data) and were then trained specifically on waste management of menstrual products. The training centered around product selection and proper disposal of each product. A discussion was held in each session on which products are available, accessible, affordable, hygienic, and environmentally friendly. After this discussion, the trainer instructed how each product would be best disposed of or properly cleaned for reuse in the case of reusable products. Discussions on waste segregation and composting were key topics during the training that led to the interventions.

## Interventions

Two long-term interventions were initiated in two of the villages, Pangmo and Demul. The first intervention is a waste segregation system and the other is a compost pit.

### a. Segregation Bins

Red and green bins were placed in the washroom of the Pangmo Nunnery with a note posted stating that non-biodegradable products (commercial pads) were to be placed in the red bin and biodegradable products (cloth pads or compostable pads) were to be placed in the green bin. The washroom location was determined by the nuns as a convenient place to discard used pads. Trash bins were already being used for other trash throughout the nunnery and allowed for these bins were to be integrated into that system. The system was inspired in part by the 2Bin1Bag waste system already in place in Bengaluru, India [16] (Figure 2).

### b. Compost Pit

A compost pit was constructed near Demul in proximity to the community landfill/dumping pit (Figure 2). The location was chosen to allow menstruating community members to dump their used compostable pads into the pit at the same time as dumping their other waste. The pit had dimensions of 1 meter x 1 meter x 1.5 meter with support walls of stone and mud [17]. A pit was chosen as opposed to a bin to be able to survive the extreme weather of winter months and keep animals from destroying the structure. A metal lid with aeration holes was created to keep animals out while allowing for proper aeration for the decomposition of pads.
**Figure 2.** Left: Red and green bins to segregate plastic menstrual waste and compostable menstrual waste. Right: Compost pit (1m x 1m x 1.5m) with supporting walls of stone and mud. The aerated lid is not shown.

<figure><img src="image_4.png" /></figure>

## Analysis

In analyzing the interview responses, a coding system was formed based on analogous recurrent answers. In this system, similar or identical answers were categorized with a number. In the case of the type of product used participants were assigned a number 0-3. Participants who stated they used a form of commercial pads were coded with a one. Participants who stated they used a commercial pad and cloth pads were coded with a two. Participants who used another product such as toilet paper were given a three. A lack of response was labeled as a zero. A full breakdown of the coding for each interview question is presented in Table 1.

<table><caption>**Table 1.** Survey answers coding system.</caption><thead><tr><td>Product</td><td>Disposal</td><td>Source of Cloth</td><td>Cloth Cleaning Method</td><td>Source of Pad</td><td>Times Changed</td><td>Pad</td></tr></thead><tbody><tr><td>Sanitary Pad = 1</td><td>Dump = 1</td><td>NA = 0</td><td>NA = 0</td><td>NA = 0</td><td>NA = 0</td><td>NA = 0</td></tr><tr><td>Sanitary Pad and Cloth = 2</td><td>Bury = 2</td><td>Old cotton cloth = 1</td><td>Not cleaned or reused = 1</td><td>Kaza = 1</td><td>&lt; 3 times a day = 1</td><td></td></tr><tr><td>Toilet Paper = 3</td><td>Burn = 3</td><td>From home = 1</td><td>Washed prior to dumping = 2</td><td>Kaza or Gompa Shop = 2</td><td>3 times a day = 2</td><td></td></tr><tr><td>NA = 0</td><td></td><td></td><td>Water and detergent and sun dried = 3</td><td>Gompa Shop = 2</td><td>&gt;3 times a day = 3</td><td></td></tr></tbody></table>

## RESULTS

### Interviews

The majority of participants used sanitary pads (81%, n = 22). The remaining participants reported the use of cloth in combination with pads (15%, n = 4) or any other material conveniently available (4%, n = 1) (Figure 3).
<figure><img src="image_5.png" /><figcaption>**Figure 3.** Participant product preference.</figcaption></figure>

Random dumping of menstrual product waste was practiced by 67% of the participants with 30% opting for shallow burying, and the other 3% choosing burning as their method of handling the waste. Used sanitary pads were dumped by more than half of the women (64%) and either buried (32%) or burnt (4%) by the rest of the users of this product (Figure 5). Participants who used a combination of cloth and sanitary pads were most likely to dump their waste (75%) with the others opting for burial (25%) (Figure 4).

<figure><img src="image_6.png" /><figcaption>**Figure 4.** Disposal methods.</figcaption></figure>

Of the participants who used cloth pads, only one cleaned the cloth properly to be reused while the other participants dumped products after the first use. All four cloth users (100%) obtained their cloth from used clothes or other old cloth from home. All participants (100%) reported obtaining their commercial pads from Kaza, the central town in the valley. A cluster of the participants (19%) from the Pangmo nunnery reported also getting their pads from a nearby Gompa Shop in addition to Kaza. Participants had varying frequencies of pad changes during menstruation with 48% stating they change their pad about 3 times a day while 26% change pads less than three times a day and 22% change pads more than three times (Figure 5). One participant (4%) chose not to respond.
<figure><img src="image_7.png" /><figcaption>**Figure 5.** Frequency of pad changes.</figcaption></figure>

## Training and Interventions

The effectiveness of the train-the-trainer model and both ongoing interventions are being monitored continuously by Ecosphere and yearly by the University of Utah Division of Public Health. The discussions held during the initial trainings directly influenced the intervention design.

## DISCUSSION

The findings highlight a significant gap in proper solid waste management training among the participants. With current trends, it is projected that more than 25,000 pads per year will be improperly disposed of in just the three villages included in this study. Given that the Spiti Valley comprises 231 villages, the scale of this issue is considerable and warrants urgent intervention.

Our study revealed that 67% of participants practice random dumping of menstrual product waste, while 30% opt for shallow burying, and 3% choose open burning (Figure 4). This is consistent with findings from other low-income regions where similar disposal practices are prevalent due to a lack of proper waste management infrastructure [3, 9, 11, 12, 17, 22]. The preference for dumping and burying can be attributed to convenience and the lack of alternatives. Such practices pose severe health risks for community members due to potential contamination [24]. The arid high desert ecosystem also has a limited capacity to absorb and break down waste [13,25]. This ecosystem already provides little fertile land, which could become even more scarce with waste buildup. If the current practice of random disposal persists, the health and livelihood of the village communities could see severe impacts.

The majority of participants (81%) reported obtaining their commercial pads from Kaza, the central town in the valley, which requires a two-hour bus journey from their villages, with some participants making the trek on foot. The travel, combined with the discomfort of purchasing menstrual products from a male shopkeeper, highlights examples of significant accessibility barriers. Additionally, no biodegradable or cloth pad alternatives are available in these shops. Local production of biodegradable pads by nunneries could address both accessibility and environmental concerns. This approach has been
successful in other regions because local production of menstrual products has empowered women and improved MHM practices [20,26]. The introduction of menstrual cups, which are reusable and produce minimal waste, is another viable solution [27]. Positive feedback from at least one nunnery in the area already using menstrual cups suggests that menstrual cups could be a culturally acceptable option when paired with proper education and support. Increasing accessibility and comfortability of obtaining and using products are key aspects in any waste management system of menstrual products.

Our interventions, including the implementation of waste segregation systems and compost pits, aim to provide sustain-
able solutions to these challenges. Similar interventions are recommended as part of the Indian Solid Waste Management
agenda established in 2022 [28] and are discussed at length in other governmental reviews [7,17]. Initial feedback indicates
that these interventions are well-received, but their long-term effectiveness will depend on continuous education and com-
munity engagement. The impact of these interventions will be monitored yearly to identify any necessary adjustments and
expansions. Expansions could extend beyond the Spiti Valley and the high Himalayan region.

Sustainable Development Goals

Improving SW-MHM practices in the high Himalayas directly contributes to several SDGs. For instance, SDG 3 (Good Health and Well-being) is addressed by reducing health risks associated with improper waste disposal. SDG 5 (Gender Equality) is promoted by empowering women through better MHM practices and local production of menstrual products. SDG 6 (Clean Water and Sanitation) benefits from improved waste management, reducing contamination risks. Finally, SDG 13 (Climate Action) is supported by promoting biodegradable products and reducing plastic waste.

Study limitations

The study was conducted in only three villages within the Spiti Valley, which may not fully represent the diversity of the entire high Himalayan region, thus limiting the generalizability of the findings. The reliance on self-reported data via convenience sampling introduces the potential for recall bias and social desirability bias, which could affect the accuracy of the reported behaviors and practices. Additionally, the interventions, including waste segregation systems and compost pits, will require continuous monitoring to determine their long-term effectiveness and sustainability. Cultural nuances may not have been fully addressed despite efforts to adapt the interventions to the local context, potentially influencing the acceptance and effectiveness of SW-MHM interventions. The study assumes the availability of resources such as transportation to Kaza for purchasing menstrual products and materials needed for local production of biodegradable pads, which may vary across different regions and impact the feasibility of scaling these interventions. Furthermore, the environmental impact assessment of menstrual product disposal practices was not exhaustive, necessitating further research to quantify the specific environmental benefits of the proposed biodegradable pads and menstrual cups compared to traditional disposal methods. Lastly, the effectiveness of the train-the-trainer model in disseminating knowledge and skills is not yet fully evaluated, and variations in the quality and consistency of the training delivered by local trainers could influence the overall success of the intervention.

***Implications for research***

Future research should focus on the long-term sustainability of the implemented interventions and explore additional strategies for improving MHM in remote regions. This includes assessing the feasibility of scaling local production of biodegradable pads, monitoring the introduction of sustainable waste systems such as waste segregation and composting, and the broader acceptance of menstrual cups. Continuous community engagement and education will be crucial for the success of these initiatives.

CONCLUSION

The intersection of menstrual hygiene management (MHM) and sustainable waste disposal in the high Himalayas presents both significant challenges and opportunities. This study highlights the urgent need for effective and ecologically sensitive solutions to menstrual waste management in regions like Spiti Valley, where conventional disposal methods pose severe risks
to both human health and the environment. The interventions implemented—waste segregation systems and compost pits— coupled with community training demonstrate potential as sustainable solutions. Moreover, this research underscores the importance of integrating MHM into broader public health and environmental sustainability frameworks, aligning with global goals such as gender equality and climate action. The lessons learned from Spiti Valley can inform similar efforts in other ecologically sensitive and resource-constrained settings, contributing to a more sustainable and equitable approach to men- strual health management globally.

**Author Contributions:** Conceptualization: TPS, CH; methodology: TPS, CH; software: TPS; validation: IK, CN; formal analysis, TPS, CH; investigation: CH, TPS, ML, CN; resources: TPS, IK, CN; data curation: TPS, CH; writing—original draft preparation: CH; writing—review and editing, CH, TF, ML, TSP, MS; visualization: CH, TPS, MS; supervision: TPS, IK, MS; project administration: TPS. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Acknowledgments:** None.

**Conflicts of Interest:** The authors declare no conflict of interest.

**Disclaimer/Publisher's Note:** The Publisher remains neutral regarding jurisdictional claims in published maps and institutional affiliations. Additionally, the Publisher is not responsible for the accuracy, completeness, or validity of the content of scientific articles published herein. This statement exempts the Publisher from any responsibility regarding the content of scientific articles, which is solely the responsibility of the authors and peer reviewers.

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<figure><img src="image_8.png" /></figure>