Is the “Green” Menstrual Movement Ableist?

I was on the last day of my period when a terrifying article popped up on my newsfeed: The world’s largest colony of Emperor penguins (those adorable tuxedoed stars of 2005’s March of the Penguins) were wiped out when the ice shelf they were standing on collapsed due to warming temperatures linked to climate change.

Sadly, it wasn’t even the most horrible environmental story that month. A United Nations report said those penguins are just one of a million species at risk of extinction if we don’t start changing our consumer habits, particularly when it comes to plastic, an ecological scourge that puts carbon in the atmosphere when manufactured and fails to biodegrade in our landfills and waterways, sickening and killing wildlife.

But here’s the problem: While I try to eliminate single-use plastic as much as possible in my daily life, I depend on some of those plastic-filled products, particularly those that I use during my period. For at least 12 weeks out of the year, I don’t just prefer, but I need those non-biodegradable Tampax Pearl applicators and Always pads, because the greener options—like menstrual cups, washable pads, and period underwear—are difficult, even impossible for me to use.

When I was 6, I was diagnosed with idiopathic juvenile rheumatoid arthritis. It didn’t take long before I lost mobility in my fingers, toes, wrists, and ankles. It has only gotten worse in the decades after, making it difficult to do seemingly simple tasks—such as inserting tampons without applicators, or removing a Diva Cup—unless I ask for help, and that’s not practical at school, work, or any place where I am alone. The hand-washing step required by most reusable pads and period underwear (like Thinx) causes pain in my fingers and wrists.

I want to be a responsible consumer, but I can’t help but worry about well-meaning environmentalists passing disposable tampon and pad bans that disregard the needs of people like me the way recent plastic straw bans did. After talking to several people with disabilities who share my concerns, I realized two major hurdles to solving the accessibility issue when it comes to greener menstrual products: No one wants to talk about periods, and disabled people who menstruate often feel ignored.

“There are taboos upon taboos,” said former Northern California hairdresser and entrepreneur Jane Hartman Adamé, whose Ehlers-Danlos syndrome now makes it impossible for her to use most menstrual cups without her dislocating a joint.

Those taboos would include discussing menstruation, unless it is in an innocuous, empowering way, using anything but blood to illustrate; sharing stories of disability, unless they’re recounted for the purpose of inspiration or pity; and finally, pointing out just how much the environmental movement, no matter how well intended, tends to ignore the disabled when pushing for solutions.

“I absolutely share your fear that able-bodied folks are going to randomly decide to ban the things that make life livable for me,” Kelly Hills, a writer and bioethicist told me. “I mean, they sure as fuck don’t care about a disabled point-of-view when it comes to straws, so I fully expect one day to be told that I should just be able to make a Diva Cup work and it’s my fault if I can’t, too bad, just stay home and bleed on a towel.”

Luckily, there are some abled environmentalists out there who understand why this is a concern for the disabled, and are trying to get the message out. “Advocating about inclusion is hard,” said Mary Imgrund, an American environmentalist who has published several articles about inclusivity and disability. “Accessibility isn’t even on the radar for some people. Environmentalist activists need to step up. It’s been a pet peeve of mine.”

What’s more, environmentalists may be better served by pushing legislators to persuade large manufacturers to go greener, instead of pushing for bans on products relied on by people with disabilities, Imgrund said. “Consumers shouldn’t have to make these choices. Rather than create a new market of alternative products like the cups, which are unusable for some, or period-underwear, which are inaccessible to many thanks to cost, there should be a push to reform the existing industry of pads and tampons,” she said.

But consumers aren’t off the hook either. Startup culture creates the illusion that new technology can solve just about any problem. And the only data the public—and for that matter, journalists—have to rely upon comes straight from the companies trying to cash in on the image of being “environmentally friendly.”

“It seems this is another instance in which conscious consumers buy into the idea that problems are solvable by startups selling exciting alternatives rather than changing and regulating existing industries to be both sustainable and accessible,” Imgrund said.

The Environmental Protection Agency, which sets the standards for the thousands of landfills in this country, has a report from 2015 which gives figures on the various materials that go into those landfills, including metal, plastic, paper, etc. The report cited an almost 5 percent rise in plastic waste in landfills since 1990, but did not break down how much of that plastic came from menstrual supplies (it did include figures on diapers and plastic plates).

As for ocean waste, a 2018 report from the European Commission, which oversees legislation in the European Union, cited “sanitation supplies” as the fifth largest ocean polluter (plastic bottles were first), but did not specify what that actually meant. However, a further breakdown showed “sanitary towels” to be ninth on the list, right above plastic straws. Tampon applicators were not included.

Environmental groups I contacted had no clear answers, though Portia Sinnott, Program Director at Zero Waste USA, was able to extrapolate how many tampons and pads were in a trash survey she conducted recently for a Northern California community.

It was one percent.

“I expected there to be more,” she said, adding that haulers sometimes don’t specify where the trash comes from. That would certainly affect the data; if the trash Sinnott was analyzing came from a retirement community, for example, it would make sense if there were far fewer tampons and pads in the mix. But why are we not keeping track of this better?

“It’s because of the ick factor. It’s not talked about. If you want zero waste, you have to talk about these things,” Sinnott said, adding that she has a hard enough time talking to people about her specialties, which are pet waste and diapers. Add blood, and everyone shuts down, including fellow environmentalists.

When asked where they got their numbers, Canada-based Lunapads, which sells reusable sanitary napkins, confirmed they didn’t come from a single official source.

“Our numbers were arrived at after compiling sales information from various sources and making some educated estimates,” said Christa, echoing India-based EcoFemme (which also produces reusable pads) and British-based DAME (no association to this magazine), which recently debuted a reusable tampon applicator. Representatives from all three companies also said they consulted various studies by environmental groups before making their estimates.

It doesn’t seem fair to be guilted into buying difficult-to-use products to manage a basic bodily function shared by half the world’s population based on incomplete data from someone trying to sell me something. I am far from alone in my frustration. The standard menstrual cup, which includes popular brands such as Diva Cup and Lunette, has been touted by its supporters as the greenest alternative due to its lifespan (up to three years), and that it can be worn up to 12 hours, then just emptied and rinsed, saving water. It is almost universally panned by disabled users.

“Throwing out my back was the most painful,” said Adamé, who used to use a cup regularly, but had to stop when her symptoms from Ehlers-Danlos got worse. For others, like Shannon L. (who requested anonymity), it’s less about mobility and more about vulvodynia (or chronic vulvar pain). Shannon also said cardboard tampon applicators are painful, though plastic is tolerable.

Reusable pads, like Lunapads, got better reviews, but still pose greater challenges to disabled users. The washing step is a turnoff for writer and disability activist Emily Ladau, who uses a wheelchair. “I haven’t tried Lunapads because of the extra work,” she said, adding that pads in general aren’t always great options for wheelchair users, because moving in and out of the chair tends to involve a lot of scooting and sliding, which makes pads bunch, and that can mean leaks.

Finally, there’s reusable period underwear, like Thinx, Knix, and Modibodi. But the washing step is once again a concern for those with mobility issues.

“Not all disabled people have the energy or available help to hand rinse and hang dry items for five days in a row,” said Alice Wong, activist and founder of the Disability Visibility Project.

It’s clear to me, and to all the women I talked to, that no one product is going to work for all people with disabilities. We have varying needs and concerns, but don’t we deserve to be considered in the design of products we need? It’s beyond frustrating and infuriating that I have to choose between being a responsible global citizen and managing my period without great expense and pain.

“Somehow you are a ‘bad’ consumer if you need disposable products versus people who can use and afford greener alternatives,” Wong says. “Each person knows what they need and what works for them and there has to be less shaming of people who may not follow the shift toward reusable items for legitimate reasons. It only drives people further away from overall engagement with environmentalism and sustainability.”

Interestingly, because of the issues they have with both reusable and disposable menstrual products, many of the people I interviewed opt for the greenest option of all: Not having a period. Women can suppress menstruation with continuous-use birth control pills, hormonal IUDs, and hormone shots and implants. It is an option I have never considered, and the reason is one I share with Wong, who told Rewire News in 2014: “Menstruation is a nice reminder that something is ‘working normally’ in my body when there are so many other aspects to my body that are not.”

Apart from that need for normality, I hesitate to use this option because the efficacy of hormonal products seems to depend on the individual—and the symptoms and side effects can pose even greater challenges. Many of the disabled people I talked to said that, far from stopping their periods, the Mirena IUD, for example, made them spot every day, or worse, bleed continuously for a month. Adamé had even less luck with Nexplanon, which is a hormone-infused rod inserted into one’s upper arm.

“It resulted in what I jokingly called my ‘forever period,’” she said. “I bled for months.” And those are not the only side effects associated with these products. Depo Provera, a hormonal birth control shot, is linked with bone loss, which can result in osteoporosis. And even the traditional 21-day birth control pill has long been tied to increased risk of hypertension, blood clots, and strokes.

Tampax and Always, both owned by Procter & Gamble, have done some work to address environmentalists’ concerns over the years. Always released a line of pads without a lot of the chemicals proven to harm the environment, while Tampax now has a cup. However, Tampax still sells the Pearl plastic applicators, which continue to be best sellers (and which a number of people with disabilities have told me are their only usable option). Though the cardboard applicators still exist, even if they are sometimes harder to find. (My local drugstore’s decision not to stock them is a big reason I started using Pearl.)

To reiterate: There are no easy answers. But there is hope. As it turns out, we just needed to send someone with a disability to do the job. Enter Adamé, whose Flex Cup, co-invented with her medical device designer friend Andy Miller, launched nationwide at Target stores in April. Unlike other cups, the Flex was deliberately designed with input from disabled testers, and includes a pull-string mechanism that breaks the suction between the cup and the cervix, making it as easy to remove as a tampon.

The idea for the Flex came about when Adamé started talking to others, disabled and abled, about her difficulties with available cups. “I learned that this wasn’t a ‘me’ issue; it was a common struggle (or fear) for able-bodied people as well. I began reading reviews of cups everywhere I could find them, and in each place I would find someone mentioning getting their cup stuck and needing to go to the ER. Maybe I’m just stubborn, but that didn’t seem like an experience we should all just be expected to overcome.”

At the moment, the Flex Cup is just available in the United States, but there are plans to launch internationally. And Adamé said this is not be the last green product she hopes to make more inclusive, and she stresses the need to attack the much larger problem at the root.

“An unfortunate part of developing for menstrual health in general is that so many customers will say things like, ‘maybe my body is the reason this isn’t working for me’ rather than demanding that we have more suitable options,” she says. “Periods are normal, just as disability is normal, and we all deserve products that work for us.”