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Safe Hygiene for Everyone, Period

Women and girls are disproportionately affected when access to safely managed sanitation is lacking. Duke ECE engineer Sonia Grego wants to change that.



Intro music:

Miranda: They kill crops.
They kill bees.
They drive dogs mad.
They’re incapable of logical thought, yet they can dull your knife or your ax or your saw with a single glance.
They’re women… on their periods.
That’s according to all kinds of cultural myths about menstruating women from all around the world, anyway.

Miranda: So I started to think about, what were these menstruating women myths in the United States, and I remembered one thing I had always heard, which was that you shouldn’t go to the beach on your period because the sharks will smell your blood—

(Sonia laughs)

—and you’ll get attacked. And I actually didn’t know whether that was true, I had to Google it! And of course it is not true, it’s just one of these crazy cultural myths. But I know you grew up in Italy, and I was wondering if you had any of those.

Sonia: Yes.

Miranda: What are they?

Sonia: So the myths are—In Italy, where I grew up, women typically do a lot of canned jam, canned goods. You cannot be a part of the canning of goods if you have a period, because it will go bad.

Miranda: This is Rate of Change, a podcast from Duke Engineering dedicated to the ingenious ways engineers are solving society’s toughest problems. I’m Miranda Volborth. In this episode I’m talking with an engineer from Duke’s Center for Water, Sanitation, Hygiene, and Infectious Disease, or WaSH-AID—

Sonia: My name is Sonia Grego, I am an associate research professor at the Duke Center for WaSH-AID, and the department of electrical and computer engineering. And I am leading projects in the space of sanitation and engineered solutions for sanitation.

Miranda: WaSH-AID works on a range of projects related to global sanitation, human health, and the environment—including the Reinvent the Toilet Challenge, funded by the Bill and Melinda Gates Foundation. Through this project, WaSH-AID is working to serve communities around the world that have inadequate or no access to sanitation. Depending on how you define the standards you want to raise everybody to, that’s somewhere between 2.3 and 4.2 billion people. Sonia oversees field testing of new sanitation technologies in India. So, she’s seen a lot of data about toilets—who uses them, when, and why, sometimes, they don’t. That data has made it clear that lack of access disproportionately affects women and girls.

Sonia: It is estimated that as many as 1/3 of schools globally lack proper sanitation and menstrual hygiene facilities, and this has a huge impact on sanitation. Now, in terms of gender equality, we all know that women need education—that lack of education has detrimental impact in terms of their life trajectory, in terms of income and quality of life. And it so happens that young girls, after they have their first period, they start to drop out of school or to lose one week per month. So this has a huge impact on their ability of education, and if you think about it, the trajectory of a woman’s life is degraded by the fact that there was not a proper place for her to dispose of a menstrual pad, I—it’s a disgrace. It’s a problem that can and should be solved. And the benefit would be so huge, in terms of education and contribution to the work force. It’s such a neglected topic, yet it has such a significant impact.

Miranda: The solution seems pretty straightforward. Why can’t toilet facilities just add wastebaskets—right?

Sonia: So here in the US, we are lucky and we have wastebaskets in locations but we also have a solid waste management system. We have people that collect he waste and properly dispose of it. This is not available in developing countries, there is not such a centralized service. And menstruation and menstrual waste in particular also has these associated stigmas, so disposal of it is a much-neglected task. There are no central services, it gets buried or burned on the premises, which is both an environmental and a health concern. So the intent for the center for WaSH-AID was to provide a comprehensive sanitation solution for users, and technologies that deal with sanitation for women need to include a solution for waste—for menstrual waste disposal.

Miranda: Enter the S.H.E. unit—Safe Hygiene for Everyone. It’s a small, clean-burning incinerator. The aim is to make the S.H.E. unit the size of a small wastebasket, so it can fit in a women’s toilet. It has a door where you drop your used pads, and it’s a co-fire process, meaning that you mix two fuel types—propane gas, commonly used for stoves, and the pads themselves. It achieves a very high temperature that ensures complete combustion. And it’s a very clean conversion, resulting in mostly CO2 and water. What’s left is a very small amount of ash—that still has to be disposed of.

Sonia: The concern with all incinerators is their potential for air pollution. You don’t want to trade an environmental pollution threat with another one. And so that was the genesis of our technology and why we are using a process designed to reach a high temperature and therefore better control the emissions. And we are conducting measurements here in the US to ensure that these conditions are met.

Miranda: Here’s the thing. For the unit to operate effectively, the WaSH-AID engineers have to know the characteristics of the materials that are being disposed of. What are the pads made of—paper, cloth? Are they commercial, are they homemade? How frequently do women change their pads? Because that affects how easily they burn. The risk of an incomplete burn is that the unit might produce a ton of smoke, and pathogens might survive. So Sonia made a big ask of her team in India: to collect menstrual waste and characterize it. I asked her how the team reacted.

Sonia: I was very surprised when the ask was, “Well, we need to characterize the contents of this, you know, menstrual waste basket.” However, that request came after we had already done education with the women on the importance of safe menstrual hygiene practices and how if women don’t change their pads often enough they get urinary tract infections and other diseases. So we had already established the practice that we needed trash bins in every toilet stall, and we have a caretaker that disposes of it and we had the education. This topic of the menstrual hygiene safety had been discussed with the team, but as I said it is still a majority of men engineers, young men, just out of school with a high education that already they are doing a job which are challenging because they are sampling toilet effluent right then and there. And then transforming it into pathogen-free water, ready for reuse, which is a fantastic thing, but they need to analyze the raw material, which is quite unpleasant. But at least that’s part of a civil engineer’s work. The menstrual waste, that was completely new, and I very shyly suggested—or indicated—that that was something we needed to do in preparation for the testing of the disposal technology. And they did not bat an eye.  And it was not only the woman engineer, but she and a couple of male engineers who provided the data for the spreadsheet. And they did not bat an eye. So I was pretty pleased.

Miranda: I read something the other day, just in the paper, that Scotland was going to have free menstrual products for everybody. What do you think about that?

Sonia: I think that access to pads in critical. I mean, as a woman, you know that the horror is to have your period being someplace and not having access to a pad. That is the nightmare for women in that period of our lives. So I think it is extremely forward thinking to have free sanitary pads and tampons available in toilets everywhere. Some of these products actually even undergo luxury tax. In India there was quite a movement against removal of the luxury tax. They were considered like a perfume, something people choose. Well, they are essential. So yes, availability of pads is a key right.

Miranda: I think the US has tax on menstrual absorbents, doesn’t it? I think it—I’ll fact-check that.

Miranda: I did look into this issue and here’s what I learned: taxes on menstrual absorbents vary by state. Thirty-five states collect sales tax on them. North Carolina, in fact, makes $7.8 million on these products every year. In Colorado, parts for private jets are not taxed, but period products are. In Idaho, treatments for hair loss are not taxed, but period products are. Tampons and pads are not optional, they’re necessities, like groceries or medicine. This kind of sex-based discriminatory pricing is called a “pink tax.”

Miranda: Another thing that strikes me is funny is that when I first started working at Duke, I noticed that a lot of the dispensers are free—you could just get a tampon or sanitary pad if you needed one. But I also noticed that the tampons were always empty.

Sonia: Yes! It’s always—yes, I’ve noticed that, too. So it is true that if good are—if dispensers are free, they may be emptied by hoarders. However, not withstanding what user behavior is, widespread availability and access to high-quality disposable pads is an unmet need.

Miranda: And it is almost exclusively sanitary pads in the places where you’re testing these technologies, right?

Sonia: Yes, that is—well. Well, well… we found a great prevalence of sanitary napkins that are commercial and disposable, but in one of the sites we also found a 10% prevalence in the use of cloth. These are rags. You know, like house rags that are used for this purpose, rewashed, and reused. This is a practice that comes from lack of access to these resources and due to the cost of commercial pads that the poorest people cannot afford. Again, because these are rewashed and then need to dry properly before you can reuse them, which you can also hardly do with discretion, this is associated with a series of health concerns.

Miranda: Here’s the other thing: the solution that this team of engineers is developing has to be affordable, as well as safe and healthy, because the alternative is free: just continuing to dump used pads into toilets, out in fields, or throwing them into rivers or streams, where they disperse pathogens. Or, burning them openly, where they release toxic chemicals into the air.

Sonia: For this unit we are targeting a price cost which is of the order of $500, plus-minus. It’s still fancier than the price of existing incinerators. Still, even existing incinerators are very little-used. As I said, in my experience, even the trash can is hardly available in a women’s toilet—that is a public facility, not a fancy one. So I think there is a need for a sensitization of the public to the needs of women in the space of sanitation and menstrual hygiene. The fact that you provide a bathroom that has running water is not enough for women users, for the reasons we have described. So I feel that overall, an education and sensitization campaign of a topic that is considered “shhh”—something people don’t talk about—is needed, so that this crucial feature is included in the budget of whoever provides the sanitation solution. We are all convinced that in terms of engineering solutions for human needs, these types of work we’re doing is the most likely—certainly in my career—that I have done that has the impact of changing life and improving health, at a scale that I cannot imagine. So I am a small cog in a big wheel, but this is the most significant work that I’ve done in my career, and I think that many of my colleagues think the same.

Miranda: Sonia would like everyone listening to know that May 28th is World Menstrual Hygiene Day—a day dedicated to breaking period stigma, dispelling shame and prioritizing the needs of women and girls. So mark your calendar for next May 28th, and celebrate World Menstrual Hygiene Day by having a slice of cake… or going to the beach on your period… or canning something… or even indulging in a little light beekeeping.

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