Abstract
Introduction
Menstruation, or period, is normal vaginal bleeding that occurs as part of a woman’s monthly cycle. It is a normal biological process that people across the world experience. When ovulation is not followed by conception, menstruation is the monthly loss of the functional layer of the uterine endometrial lining. The first menstrual cycle in an adolescent individual is known as menarche. It happens every 28 days on average but can happen anywhere between 21 and 45 days. Menarche occurs around an average age of 12.4 years. Menstrual periods typically last 3 to 7 days, with periods lasting more than ten days considered irregular. Menarche is a marker of an adolescent individual’s body growth.1.8 billion people in the world menstruate once a month. Millions of girls, women, transgender men, and non-binary people cannot control their menstrual cycle respectfully and healthily.
According to studies by Whisper and UNESCO, over 71 percent of adolescent girls in India are uninformed of menstruation until they get their first period, which has a negative impact on their confidence and self-esteem. In India, sanitary pads are used by less than 20% of the 40 million menstruation women. This figure only rises to 52 percent in metropolitan regions. That means nearly half of even city-dwelling women utilize unsanitary techniques for period protection, putting them at risk of health problems.
India has several menstrual hygiene products with a substantial menstruating population. From conventional sanitary napkins tampons to products like reusable pads, sponge tampons, period pants, and menstrual cups (Both reusable and disposal).
A menstruation cup is a reusable feminine hygiene product. You place a small, flexible funnel-shaped cup made of rubber or silicone into your vagina to trap and collect period fluid. The product has a market share of 1–2 percent of the total industry in India. Because cups can store more blood than other techniques, many women prefer to use them instead of tampons or pads because they are more environmentally friendly. A menstrual cup is a long-term economical option as it can endure up to ten years. The cups also produce less waste, which is unsurprising. According to the review’s findings, one menstrual cup generates 0.4 percent of the plastic trash made by single-use pads over ten years, or 6% of the waste generated by tampons. They are also traveling and activity-friendly, making them a perfect alternative to conventional pads. They reduce irritation, prevent leakages more than other sanitary products, and do not emit any odor. Being an ideal alternative, Menstrual cups have still not penetrated Indian markets in expected ways. In this paper, we deep dive into the accessibility and feasibility of menstrual cups in urban areas of India to understand the pace of the shift from traditional sanitary products to menstrual cups
Purpose of the study
India has a menstruating population of about 355 million individuals. In India, sanitary pads are used by less than 20% of the 40 million menstruation women. This figure only rises to 52 percent in metropolitan regions. This means that nearly half of even city-dwelling women utilize unsanitary techniques for period protection, putting them at risk of health problems. Statistics suggest that only 57.6 percent of women in India use sanitary napkins. Others use cloth and even leaves that lead to vaginitis and urinary tract infections, sometimes also lead to death if not treated properly. Thus, menstrual hygiene is the need of the hour, and sanitary products need to be made more accessible to women, both rural and urban. We wanted to look into the issues and the reasons behind the low acceptance rates of sanitary products in an urban setting. There are multiple sanitary product options available these days, right from sanitary napkins, tampons, menstrual cups, and so on. Thus, we conducted a study on the acceptance rate among women of these products in an urban setting.
Literature review
This systematic review looked at numerous quantitative and qualitative research published across various papers about menstrual cup experiences and issues and awareness and attitudes of menstrual cups. We came across a survey where lack of privacy is a key worry in households and schools. Many issues are also caused by the mother’s and child’s misinformation, misconceptions, dangerous habits, and illiteracy about menstruation. As a result, there is a critical need to encourage adolescents to engage in safe and hygienic behaviors at school (Kaur & Kaur, 2018). Another study was made to compare the physical and mechanical properties of menstrual cups. The findings also indicated that women are not sufficiently informed when choosing a menstrual cup, and transparency is needed across menstrual cup brands (Hannah Manley, 2021).
In yet another study, Girls expressed concerns about the loss of virginity, leaking, and fertility among Nepalese school-aged adolescents. Furthermore, it was discovered in this study that supports from teachers, family members, and peers can dramatically minimize the stigma associated with the usage of a menstrual cup (Bhattarai., 2021) One of the studies also focused on the uptake and maintenance of cups used by school girls in Kenya. The findings indicated that strong research communications and goodwill among the schools and community to examine this unmet need for schoolgirls may have strengthened resolve to participate (Anna Maria van Eijk & Garazi Zulaika, 2019).
A systematic review of the literature and assess the acceptability and safety of the menstrual cup as a feminine hygiene product was conducted in this Study (Camilo Arenas-Gallo et al., 2020). This research confirms that the menstrual cup is a comfortable, safe and efficient alternative for menstrual hygiene compared to sanitary pads and tampons. A study aimed to assess menstrual cups’ adaptability and effectiveness by naïve users who have been using sanitary pads/tampons/cloth as conventional menstrual sanitary protection. It was also concluded that this reusable vaginal device (menstrual cups) has no significant health risks and is acceptable to many women without the need for fitting or other medical services (Bhatt, 2017).
There is a significant disparity in women’s knowledge and willingness to adopt the menstrual cup (Meghana, 2021). Studies were also conducted to know more about menstrual cup leakage, acceptability, safety and explored menstrual cup availability to inform programs. It was found that menstrual cups are a safe option to switch to; further studies are needed on cost-effectiveness and environmental effect comparing different menstrual products (Anna Maria van Eijk & Garazi Zulaika, 2019). According to a paper (Aishwarya, 2019), most women in Bangalore are already using menstruation cups. They are well-informed about them, which shows that social media is a potent source of information, with most participants getting their information from it. The menstrual cup’s durability, low economic costs, eco-friendliness, and reusable nature were cited as the key reasons for its popularity in the same survey. Another study looked into the knowledge, attitudes, and practices of rural reproductive women regarding the menstrual cup. Many participants were aware of the use of the menstrual cup, but it was found that acceptance of the cup is still lacking. According to another survey, Menstrual cups have the advantages of a simple design, cheap cost, convenience of use, and reusability. They may help women manage their menses more effectively in various social and cultural circumstances (B North, 2011).
We might hope that increased global knowledge of women’s health issues, along with targeted teaching efforts, would bring menstruation management out of the shadows, making a “period” little more than a minor annoyance.
Research objective
In this backdrop, this study aims to understand the issues, preconceived notions and views, general perception around a new concept, and how tough will it be for menstrual cups to penetrate India as a market entirely. In the future, this will help define, create products, and target offerings to these homogenous groups. The specific objectives of this research paper are to understand:
Consumer perception about menstrual cups with urban individuals as the target audience. The product’s feasibility and accessibility that urban women are comfortable using, and segregate them into similar groups
The purpose of this study was to look at the acceptability and consumer perceptions of menstrual cups as a menstrual hygiene management tool. This cross-sectional study was conducted on women between 18 and 45 who were willing to participate in the study. A pre-made questionnaire was used to collect the necessary information. The demographic data included age, city, sanitary products used, participants’ understanding of the menstrual cup, worries, and attitude toward the same were all included in the questionnaire. Data were analyzed using IBM SPSS Statistics 26, and cluster analyses were used to evaluate the results.
Research on the biological process of menstruation suggest that the onset of menstruation, menarche if usually between 10–17 years and thus we have taken into account females right above the age of 18 to maximize the chances of the surveyed experiencing the monthly phenomenon. Similarly, the menopausal transition most often begins between ages 45 and 55 thus we have taken the bracket of women ageing between 18 to 45 years. Thus, menstrual products are most likely to be used by these individuals and make them are ideal target audience.
We made a questionnaire on the basis of facts and data gathered by us during research on the various factors that push women to buy sanitary products right from their satisfaction with their current products to the inhibitions (if they have any) about menstrual cups keeping in mind the major factors like scare of allergies or usage of UDIs that was preventing them from using menstrual cups.
Defining dimensions
Limited Knowledge: Not knowing much about the packaging, contents, usage, safety of a product might lead to people not wanting to or not being super keen to use a product. Discomfort: Since the usage method of menstrual cups is very different than the normal menstrual products, the insertion part of it might be a reason for discomfort and people not being very comfortable for using the product. Leakage: Leakage is a concern when it comes to almost every menstrual product, even with menstrual cups as well. Allergies: With various skin types it becomes really difficult for individuals to get accustomed to a certain type of product, let alone a product that is new and still developing, allergy scares act as a big part of consumer decision. Insertion Techniques: Since Insertion products are not very well received by the Indian consumers, even the usage and handling of the same raise concerns. Toxic Shock Syndrome: Menstrual cups are usually associated with toxic shock syndrome and it is seen as a negative outcome of using a cup, where the consumer might not be physically ready for insertion.
We also focused on various factors like:
Pricing and Payments: How much they would be willing to pay for a menstrual cup. Usage: Did they think the usage was convenient or not. Product Availability: If they used the cups, where did they purchase the same from. Product Choice: If they used the cups, which brand were they most comfortable with. Product Knowledge: What did they think the product was made of- silicon, plastic or so on.
In this study total of 216 participants were examined. Among them, the maximum of participants was in the age group of 18 years to 25 years (76.38%). Based on geographical location, the distribution was tier 1 cities (63.1%), tier 2 (29.91%), and tier 3 (6.97%). Among them, 99.07% of the studied participants knew the menstrual cup, but only 43.35% had reasonably good knowledge about the same. 58.80% of the participants got information from media, 26.39% from friends, 8.3% from family and other sources. And so, it turned out that around 52.3% of the participants found it challenging to use menstrual cups, and in total, 16.4% of people use them. When asked about their satisfaction level with the current sanitary products they are using, around 76.88% of people suggested high satisfaction, so the likeability to shift to any other product also turned out to be less.
So we further conducted a cluster analysis to identify the groups and analyze the participants’ consumer behavior to understand the situation better. Based on the parameters and the details the 3 clusters were identified and named as Unaware and Unwilling, Aware and Willing and lastly Aware and Indifferent (Refer Table 1: Cluster Analysis Output)
Cluster analysis output
Cluster analysis output
MC
In Cluster 1 (unaware and unwilling), people aged 18–28 in Tier 2 cities are reasonably satisfied with the current sanitary products they use From the data given, it can be concluded that they have limited knowledge on menstrual cups and their usage and are also unwilling to shift to menstrual cups. They have a lot of preconceived notions about menstrual cups concerning leakage, allergies, insertion technique, IUD and find its usage complex and challenging.
In Cluster 2 (Aware and willing), people fall in the age between 18–25 and belong to the Tier 1 cities and are highly satisfied with the current sanitary products they use. From the data given, it can be concluded that they are well aware of menstrual cups and their usage. Majorly, this cluster consists of individuals who already use menstrual cups. This is the only cluster willing to pay higher for menstrual cups among all. They didn’t have due concerns regarding the usage of menstrual cups.
In Cluster 3 (Aware and indifferent), people fall between 22–32 and, belong to the Tier 1 cities and are moderately satisfied with the current sanitary products they use. From the data given, it can be concluded that they are aware of menstrual cups and its usage but are majorly concerned about the insertion techniques. This cluster consists of individuals knowledgeable about the product but indifferent; they may or may not switch to menstrual cups soon.
Through the data we analyzed, we were able to identify three types of clusters. In Cluster 1 (unaware and unwilling), people aged 18–28 in Tier 2 cities are reasonably satisfied with the current sanitary products they use For marketing to this cluster, we really need to deal with the pre-conceived notions they have and should go ahead with the route of educational marketing.
Taking a route of breaking myths through advertisements, workshops and camps in remote areas along with distribution of free samples, since the group doesn’t seem to be a group that would buy menstrual cups until they have tried and tested and know they are beneficial.
In Cluster 2 (Aware and willing) and Cluster 3 (Aware and Indifferent) we need to present them with more compelling facts that would make them shift from their current method of using sanitary products. We could use the environmentally friendly aspect to market to these clusters and the cost-effectiveness as well.
The limitation of this study is that the target respondents being from tier I cities mostly, this can be further extended to other cities also. The opinions and the data collected are based on a small fraction of the menstruating population throughout the country. Next comes the Age bracket in which we identified that among 216 participants, the maximum of participants was in the age group of 18 years to 25 years (76.39%), which couldn’t provide a clear understanding of the usage, willingness, and problem faced by other age groups. Lastly, based on city, the participant distribution for tier 1 cities (63.12%), tier 2 (29.91%), and tier 3 (6.97%) were as stated, respectively. It indicates that the survey data majorly comes from a menstruating woman in tier 1 and tier 2 cities and has limited data on the perceptions of the menstrual cup in tier 3 cities.