Blood flows: mapping journeys of menstrual waste in Blantyre, Malawi



Roxburgh H, Magombo C, Kaliwo T, Tilley EA, Hampshire K, Oliver DM & Quilliam RS (2021) Blood flows: mapping journeys of menstrual waste in Blantyre, Malawi. Cities and Health.

The interplay between menstrual waste and urban sanitation infrastructure is largely hidden from view. Qualitative research has highlighted socio-cultural aspects of menstruation, but few quantitative studies have mapped the physical situation at scale. This study surveyed 258 women in Blantyre, Malawi about their menstrual absorbent choices, disposal practices, and socio-demographic characteristics. A Sankey diagram visualised flows of menstrual waste in the urban environment and identified ultimate disposal points. Most participants used either disposable pads and/or old cloth and disposed of them by either burning and/or throwing in pit latrines. Pad and cloth use were associated with age, education, employment, marital status, and household wealth. Younger women’s preference for disposable pads suggests that demographic shifts may cause volumes of menstrual waste to increase. However, differences in waste volume produced by disposable and reusable absorbents was less than previously assumed. The volume of menstrual waste discarded in pit latrines, and cultural barriers to disposing it elsewhere, highlights challenges for the pit emptying industry and faecal sludge value recovery sector, with the problem anticipated to be most acute in high-density settlements. Widening access to sustainable disposal strategies, affordable reusable menstrual products, and tackling stigma, are key to addressing this social and environmental challenge.

Menstruation; Solid waste; Sanitation; Faecal sludge; Gender

Output Status: Forthcoming/Available Online

Cities and Health

StatusIn Press
FundersNatural Environment Research Council
Publication date online17/05/2021
Date accepted by journal25/03/2021

People (3)


Dr David Oliver
Dr David Oliver

Associate Professor, Biological and Environmental Sciences

Miss Heather Purshouse
Miss Heather Purshouse

PhD Researcher, Biological and Environmental Sciences

Professor Richard Quilliam
Professor Richard Quilliam

Professor, Biological and Environmental Sciences