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Menstrual and incontinence waste are the discarded items used to manage menstruation or incontinence. They include purpose-made products such as sanitary pads, tampons, panty liners, incontinence pants, adult (or infant) diapers and other materials used such as cloth or fabric. Despite obvious differences between menstrual and incontinence products, the management of both waste streams has much in common and is therefore combined in this section.
As discarded menstrual and incontinence products can constitute a significant waste flow in humanitarian contexts and pose an increased risk to health, menstrual and incontinence waste requires careful handling. Proper management is crucial to prevent contamination, control the spread of disease and protect public health and the environment. Despite the commonalities, incontinence waste is a higher health risk than menstrual waste due to its greater contamination with faecal pathogens and implications for subsequent waste management.
Menstrual hygiene concerns most women and girls of reproductive age for several days each month. Incontinence (the involuntary leakage of urine and faeces) can be considered a health condition. It particularly affects the elderly, women after giving birth, people with disabilities, traumatised individuals (including older children experiencing psychological distress) and people with certain chronic diseases. The type and severity vary by person and can be temporary or chronic. Many people (but not all) with an increased risk of incontinence are members of groups whom development and humanitarian actors often consider vulnerable or disadvantaged. They can also become marginalised due to their incontinence. For the sake of simplicity the management of infant diapers – often a considerable waste management challenge – is here incorporated into incontinence waste management due to their similar properties.
The management of menstrual and incontinence waste is challenging due to the nature of the materials involved and because of the prevalent negative cultural beliefs and stigma around the topic.
Sustainable waste management practices for menstrual and incontinence products include hygienic and convenient handling, reducing the amount of waste as far as possible, appropriate disposal methods, facilities that offer sufficient privacy, dedicated collection and transport systems and the identification of final disposal options. Public awareness and education about waste handling are essential components of responsible waste management. Socio-cultural norms, along with the availability of waste management systems and waste classification practices, can vary significantly. These differences may result in diverse, localised approaches to managing menstrual and incontinence waste. For instance, countries may classify menstrual waste differently. They may categorise menstrual waste as either (1) a general solid waste product or (2) a medical waste product (despite ‘medicalising’ waste being seen as problematic as it can further marginalise people who menstruate). If the government or camp authorities have not determined the category, it is recommended that this waste should fall into the solid waste category.
The neglect of the management of menstrual and incontinence waste can also lead to protection issues X.9, for example, because women may go out at night to bury U.8 or dump U.10 or burn U.11 their menstrual products.
Disposable products, such as disposable menstrual pads or infant and adult diapers, are widely commercially available. They are easy to distribute in an early-onset emergency and to people in transit. However, they require constant repeat distributions and are disposed of after a single use, often leading to their uncontrolled disposal in the environment (or in toilets). Most disposable products contain superabsorbent polymer (SAP), typically made from sodium polyacrylate. SAP can absorb and retain large quantities of liquid relative to its own mass but creates persistent non-biodegradable waste and potential microplastic pollution.
A more environmentally and financially sustainable solution that can significantly reduce the volume of menstrual and incontinence waste is reusable products (e.g. reusable menstrual pads, cloths, menstrual cups, period underwear, washable incontinence pants, diapers and pads). However, women may object to reusable products and using them calls for different behaviours (e.g. washing and drying instead of disposal). Additional infrastructure is required, such as dedicated places for discretely washing and drying materials and safe storage options. Reusable materials must be regularly cleaned with soap and water and fully dried to ensure hygienic and comfortable reuse. Shortages of water and soap make this challenging, as do humid conditions (e.g. during rainy seasons) which prevent materials from drying properly. Furthermore, drying reusable materials in public is viewed as undignified and unacceptable and beneficiaries do not want others in the family or community to see them. The secrecy often leads women to reuse damp materials that had insufficient time to dry or were dried under mattresses, under clothing or in other unsanitary locations. Being unable to wash, dry and store reusable materials properly can lead to health and hygiene problems, bad odours, discomfort and the premature disposal of the material by users.
The people who menstruate, people with incontinence and their carers must be actively engaged or, at minimum, consulted before distributing reusable items and products. Training, awareness-raising and discrete, culturally appropriate demonstrations may be needed to encourage acceptance and use, reducing the likelihood of the items being unused and going to waste. Inviting non-affected populations (those who do not menstruate or have incontinence) to similar sessions and other forms of hygiene promotion can improve community acceptance and understanding of these sensitive topics. Sessions should pay particular attention to taboos, myths and values about menstruation and incontinence.
Distributions of reusable items should include additional soap, water and disinfectant to enable proper reuse and avoid premature, unnecessary disposal. Reusable products will eventually have to be thrown away, so adequate disposal options are still required, though less frequently. A reusable menstrual cup can last up to ten years; reusable menstrual pads and pants, and incontinence pants can last between one and three years (depending on the quality, amount of exchange products and care).
If disposable products are the only feasible option, identify more environmentally friendly products such as biodegradable menstrual or incontinence products.
Menstruation and incontinence remain highly sensitive topics deeply affected by cultural taboos, stigma and secrecy. Local mythology and taboos can influence how menstrual materials are disposed of; understanding these beliefs when designing appropriate waste management systems is crucial. Consultations with those concerned (including waste handlers who collect and transport the waste) are essential. People who menstruate and people with incontinence and their carers often avoid taking waste materials out of the toilet or being seen washing their materials.
Public and/or household sanitation facilities must therefore protect privacy, be accessible night and day and lockable from the inside. They should provide spaces for safely and discretely changing materials (ideally with a hook for hanging clothes) and discrete waste disposal options inside toilet stalls (such as disposal bins with lids or a chute system to an outside covered pit U.8) or discrete access to a contained burning option nearby U.12. Handwashing facilities with soap and water should be installed close to disposal areas.
People with incontinence need up to five times more soap and water than others. Women and girls also need more soap and water for personal hygiene during menstruation, to wash soiled underwear and bedsheets and, if used, to wash reusable items. Areas for discretely washing, drying and storing reusable materials are needed, including leakproof bags for incontinence materials and to store menstrual materials between monthly periods.
A mirror inside the facility is also recommended so that users can check their clothing for blood stains, urine or faecal residues, enhancing their confidence and dignity. Visible blood in bathing or laundry water can be embarrassing; covered drains reduce this exposure.
The need for disposal systems is particularly urgent where single-use materials such as disposable pads are used. Reusable materials also require end-point disposal (although less frequently) but this option is frequently overlooked. Without a formal and discrete waste disposal system, used materials are often dropped into pit latrines, cesspits, septic tanks and open drains, or buried or indiscriminately disposed of in the environment (e.g. in forests or rivers). Direct disposal into toilets provides a particularly convenient, discrete and instantly available option. However, it leads to problems such as increased fill-up rates of pits or the need for laborious manual removal of solid waste prior to desludging, to prevent desludging equipment from getting clogged up W.6.
Menstrual and incontinence materials are often disposed of with general domestic waste. Where there is a functioning SWM service chain, this works well, unless the waste is manually sorted for recycling and resale. The sanitary waste may be discarded in unsightly, publicly visible piles, disregarding local taboos or perceptions; this should be closely monitored. A potential solution is to conceal the waste in black or opaque bags or paper or tissue before collection.
Covered waste bins are recommended for all public, communal and household toilets and washroom cubicles. Ideally, waste bins should be waterproof and washable (e.g. plastic or metal) or lined with plastic bin liners. To reduce theft and other uses of the bins, holes can be punched in the containers, or the bins can be physically attached to the wall or floor. Alternatively, a chute disposal system can deposit the used products directly into a locked covered bin or deep covered pit outside the toilet. Behaviour-change campaigns about the proper disposal of menstrual waste are recommended as well as visual placing information signs inside the cubicle.
For incontinence waste, dedicated and clearly marked disposal bins in men’s and women’s toilets are recommended or leak-proof, sealed bags provided, to prevent odours and contamination. If people with incontinence use handheld urine containers, bed pans or commode chairs, safe disposal options for the urine or faeces must be identified (e.g. the importance of emptying into toilets). Otherwise, people may be unaware of the risks and empty the contents into open drains or open areas outside.
The waste in bins inside or outside the toilets, washrooms or households must be frequently emptied, collected and transported to a final disposal site. Menstrual waste is not usually kept separate but collected with other waste streams. To reduce the health risks for waste handlers, precautions may be needed for incontinence waste due to its higher pathogen load, which may also affect its subsequent treatment or disposal. Incontinence waste should be kept separate during transport using separate vehicles or designated collection devices to avoid cross-contamination with other waste types. If incontinence waste is combined with menstrual waste, the bins need to be bigger and emptied more frequently.
Toilet cleaners and waste handlers must be trained properly and equipped with Personal Protective Equipment (PPE) such as gloves, masks, overalls, waterproof footwear and containers for safe collection and transport X.4.
A schedule should be established for the regular collection and replacement of disposal bins. The system needs constant monitoring of, for example, waste accumulation rates, the use in practice of the disposal facilities, whether unwanted disposal options are still being used, or compliance with proper handling approaches during collection and transport.
Menstrual and solid incontinence waste materials can be burned in a furnace U.12 on-site or at a final disposal point. Although the practice is often recommended – particularly in various menstrual health and hygiene guidelines – caution is advised as the furnaces may not consistently reach the temperatures required and, when burning at lower temperatures, they can release toxic and harmful emissions. Disposable (and some reusable) menstrual and incontinence materials can contain polymer liners which, when burned at lower temperatures, typically release asphyxiant and irritant gases into the atmosphere. Further, the biodegradable components in disposable pads, such as cellulose, wood-pulp and cotton, often contain furans and dioxins. The World Health Organization recommends that all health-related waste should be burnt at temperatures over 800°C to avoid the release of toxic and irritant chemicals. As contained burning U.12 may not achieve this standard, it should be carefully evaluated before use.
Contained burning - often called incineration - requires electricity or fuel sources, trained operators and a regular burn schedule. If combined and burned with domestic solid waste, emissions are similar to other household waste streams. If contained burning cannot be avoided, the location’s position relative to human populations need to be carefully assessed so that smoke and emissions do not become an immediate health hazard.
Strong taboos or myths may exist in communities about burning menstrual sanitary waste (or its handling by other people), which may limit the usefulness of contained burning (or collection systems). In some countries, people believe that anything a baby uses is connected to its soul, including diapers. The burning of diapers (or discarding them in the waste) is considered harmful to the baby's soul so diapers are often disposed of in rivers instead. Hence community consultation X.2 and hygiene promotion interventions X.6 are critical.
In the absence of existing waste disposal sites, dedicated facilities should be established for all solid waste (including menstrual waste), such as controlled pits U.8 – either onsite or offsite – or controlled disposal sites/landfills U.9. If pits are close to, or within, settlements, people may dislike seeing used pads in pits and avoid using them for menstrual waste. Final disposal needs to be conducted in a manner and location that avoids creating health, safety or environmental problems for the host and affected populations.
For incontinence waste, coordination with available local waste management services is recommended to ensure compliance with public health regulations for sanitary landfills, incineration facilities or relevant parts of the sanitation and faecal sludge management system. If faecally-contaminated incontinence waste is disposed of in landfills it may pose significant health risks to local waste pickers. These risks must be adequately addressed through, for example, hygiene campaigns, handwashing facilities X.6 and the provision of PPE X.4.
Effective menstrual and incontinence waste management requires regular operation and maintenance of all sanitation and washing facilities and the entire service chain. Cleaners and waste handlers need proper PPE and regular training on safety measures and protocols X.4. Operation and maintenance, including costs for personnel and training, must be included in project budgets. Responsibilities should be clearly assigned for all relevant tasks (such as regular cleaning, emptying of disposal bins, controlled waste burning or transport to a final disposal site) and scheduled (usually daily). Because of taboos, cleaners and waste handlers may need to be sensitised for their roles. Male cleaners may be unsuitable for facilities used by women and girls and more reluctant to handle menstrual waste. Women and girls may be reluctant to discard their waste if they know it will be handled by men.
Menstrual and incontinence waste management should always be accompanied by hygiene promotion and communication measures X.6. The public needs to understand how the system works and how the affected individuals (and care givers of people with incontinence) need clear and practical information about disposal methods and intended hygiene practices such as handwashing, washing reusable materials, collection times and cleaning schedules. Depending on the context, hygiene promotion includes changing norms and behaviours and awareness-raising measures on current unwanted behaviours (such as disposing of the waste in pits and its potentially negative impact). Signs and visuals inside the facilities are useful to inform people about proper disposal methods and hygiene practices. For people with incontinence, psychosocial support services may be helpful to share resources and information.
Monitoring and Refinement
Once the waste disposal system is up and running, consultation with the targeted population should continue X.3, using focus group discussions, key informant interviews, observations and transect walks. This helps to assess whether the system is meeting the needs of people who menstruate and people with incontinence. People’s feedback can be used, as required, to adjust the design and operation of the waste management system. Hygienepromoters and leaders of the consultations should be aware that because of the taboos associated with menstruation and incontinence, challenges may not be openly disclosed.
IFRC (2020): Menstrual Hygiene Management. Guidelines and Tools. Guidelines and Tools, Switzerland
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