A fine balance: A review of incinerators for menstrual waste and recommendations for policy and practice

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Menstrual health and hygiene is a public health and human rights issue. Amid growing access to menstrual health products and education, there is limited focus on end-of-life management and environmental impact of single-use products. Burning is a common practice to dispose of pads globally, with pad incinerators becoming widely available in India and parts of sub-Saharan Africa. However, known literature does not provide insights into the current product landscape for practitioners, researchers, or funders. Thus, this review aimed to identify and characterize incinerators designed specifically for menstrual pads and to propose recommendations for effective onsite incineration. Incinerators were identified using Internet searches, web forum posts, and key informant interviews. A custom coding form documented and summarized product characteristics. An estimate of the total cost of ownership (TCO) was computed. The ‘Availability, Accessibility, Acceptability, Quality’ framework was adapted to identify technology strengths and failures. This review identified 69 incinerators from 30 global manufacturers. Estimates of a 10-year TCO ranged from USD 153 to 149,900, with electricity being the largest driver of cost. Incinerators were found to largely lack safety features, such as emissions controls. This review provides key recommendations for a variety of stakeholders, including manufacturers, policymakers, regulators, researchers, and technical experts.