“Monthly Flower Blooms and Sheds off”: Awareness, Hesitancy, and usage of Sustainable Menstrual Products among College Students of Pathanamthitta District, Kerala

Background: Sustainable menstruation refers to using environment-friendly products such as menstrual cups, menstrual discs, period underwear, and reusable pads to benefit the nature around us and for our economic benefits. Although it has been several years since menstrual cups came into the market, there is a paucity of data related to their usage, awareness, and hesitancy in the Indian context. This study aims to explore the proportion of young adult menstruators who use sustainable menstrual products, the level of awareness and hesitancy in using these products, and the reasons associated with hesitancy. Methods: A cross-sectional study was conducted among 1200 female college students in both medical and nonmedical colleges in Pathanamthitta District, Kerala. Among three medical colleges and 17 arts colleges in Pathanamthitta District, two medical colleges and four Arts colleges (clusters) were randomly selected and all students who were willing to provide consent for the study from the selected colleges were interviewed using a structured interview schedule. Results: The mean age of the students was 20.65 ± 3.2 years. The majority [88.8% (1065/1200)] of the students were aware of sustainable menstrual products. However, a vast majority, 94.25% (1131/1200), still used sanitary napkins, and only 5.75%, (69/1200) used menstrual cups. Despite having adequate knowledge about menstrual cups, only 33.6% (403/1200) were willing to switch from sanitary pads to menstrual cups. The reasons cited for hesitancy in using sustainable menstrual products like menstrual cups were fear of pain during insertion, anxiety, and lack of adequate knowledge and confidence in introducing a foreign body into the vagina. Conclusion: Most college students were well aware of sustainable menstrual products, including their environmental and economic advantages. Notably, all medical and nonmedical students who used menstrual cups (100%) reported that they made menstruation easier and more cost-effective and expressed willingness to continue their use. However, actual usage remains low, reflecting a gap between knowledge and practice. The reasons cited were anxiety and fear of pain during insertion, which may be addressed by regular awareness campaigns in colleges.