A novel banana fiber pad for menstrual hygiene in India: a feasibility and acceptability study

Background: Menstrual hygiene products used by women have evolved in the past several decades with comfort, ease of use and cost driving women's choices. In a country like India, where women form nearly 50% of the population, the sheer volume of periodic menstrual non-biodegradable waste generated has significant environmental implications. With majority of the country hailing from low-middle class backgrounds, observing healthy menstrual hygiene practices with environmentally friendly products necessitates the consideration of affordable and highly sustainable alternatives. Further, during the COVID-19 pandemic, period poverty is higher than ever, causing women to turn to the reusable product market for affordable and long lasting alternatives. Hence, we studied the Feasibility and Acceptability (FA) of a novel banana fiber based menstrual pad (BFP) amongst women living in rural and urban environments. Methods: The quantitative study of FA of the BFP was conducted amongst 155 rural and 216 urban participants in India. For greater authenticity of the FA study, we considered participants who used BFP for more than 4 months (Rural = 111 and Urban = 186) in the study. The survey data included responses from participants from Bihar, Delhi, Karnataka, Kerala, Maharashtra, Tamil Nadu and West Bengal. A 22-item survey instrument was developed and validated using Exploratory Factor Analysis (EFA) and reliability test (Cronback's alpha). Binomial logistic regression analysis was used to analyse the factors that affect the FA of BFP based on the survey responses. In addition to survey analysis, environmental sustainability through CO2 footprint analysis, microbial load, pH and the ability of the BFP to withstand pressure after absorption were also studied. Results: The results indicated high levels of feasibility (rural = 82.2%, urban = 80.3% and acceptability (rural = 80.2%, urban = 77.5%) of BFPs across both participant groups. Comparing key BFP characteristics such as leakage and comfort to participants' prior practices revealed general satisfaction on the performance of BFP, leading to them recommending BFPs to others. User perception on the reasons for their preference of BFP highlighted their concern for environment, health and cost as decisive factors. The microbial load on a 3 year reused BFP was found to be similar to an unused BFP. Regression analysis showed cost as an important indicator for feasibility (OR = 1.233; 95% CI = 1.083-3.248) and acceptability (OR = 1.422; 95% CI = 1.203-3.748) amongst rural participants. Conclusion: Based on feasibility and acceptability results, BFP is a promising consideration as an environmentally sound, non-invasive; yet reusable alternative to fulfil MHM needs in populous countries such as India. Longer term studies in larger samples are necessary to validate these findings.