Holistically sustainable continence care: A working definition, the case of single-used absorbent hygiene products (AHPs) and the need for ecosystems thinking.

Incontinence is a common health issue that affects hundreds of millions of people across the world. The solution is often to manage the condition with different kinds of single-use continence technologies, such as incontinence pads and other absorbent hygiene products (AHPs). Throughout their life cycle, these fossil-based products form a remarkable yet inadequately addressed ecological burden in society, contributing to global warming and other environmental degradation. The products are a necessity for their users' wellbeing. When looking for sustainability transitions in this field, focus on individual consumer-choice is thus inadequate - and unfair to the users. The industry is already seeking to decrease its carbon footprint. Yet, to tackle the environmental impact of single-use continence products, also societies and health systems at large must start taking continence seriously. Arguing that continence-aware societies are more sustainable societies, we devise in this article a society-wide working definition for holistically sustainable continence care. Involving dimensions of social, ecological and economic sustainability, the concept draws attention to the wide range of technologies, infrastructures and care practices that emerge around populations' continence needs. Holistically sustainable continence care is thus not only about AHPs. However, in this article, we examine holistically sustainable continence care through the case of AHPs. We review what is known about the environmental impact AHPs, discuss the impact of care practices on aggregate material usage, the future of biobased and degradable incontinence pads, as well as questions of waste management and circular economy. The case of AHPs shows how holistically sustainable continence care is a wider question than technological product development. In the end of the article, we envision an ecosystem where technologies, infrastructures and practices of holistically sustainable continence care can flourish, beyond the focus on singular technologies.