WRAPPED IN

SECRECY
TOXIC CHEMICALS IN
MENSTRUAL PRODUCTS

A report by Toxics Link

1
About Toxics Link
Toxics Link is an environmental NGO, dedicated to bringing toxics related information into the public domain
both relating to struggles and problems at the grassroots as well as global information to the local levels. We
work with other groups around the country as well as internationally in an understanding that this will help bring
the experience of the ground to the fore, and lead to a more meaningful articulation of issues. Toxics Link also
engages in on-the ground work especially in areas of municipal, hazardous and medical waste management and
food safety among others. We are also involved in a wider range of environmental issues in Delhi and outside as
part of a coalition of non-governmental organizations.

Our work on Bio medical waste management has spanned over 20 long years, entailing significant diverse body
of work such as policy engagement, improving on ground compliance to the rules, involved in setting standards,
creating models in healthcare facilities, ongoing research on occupational safety, training and capacity building
of all stakeholders and creation of training modules. The Toxics-Free Health Care programme of Toxics Link has
worked extensively for ensuring responsible health care practices and use of safer technologies in India, and
strong commitment to a clean and safe environment. The programme aims to green the healthcare practices in
the country.

Acknowledgement
Our sincere thanks to TÜV SÜD South Asia Pvt. Ltd for conducting the analysis for the samples. We take this
opportunity to also thank all those who helped us in shaping this report.

We express our sincere gratitude to the Swedish Society for Nature Conservation (SSNC) for supporting this study.

Study and Report by Priti Banthia Mahesh, Toxics Link

Dr Amit, Toxics Link
with inputs from Dr Aakanksha Mehrotra, Toxics Link
Contents Abbreviations3

1. Introduction
1.1 History of sanitary pads
4
6
1.2 Market share of sanitary pads 7
1.3 Composition of sanitary pads 8
1.4 Menstrual Products & Sustainable Development Goals 9

2. Toxic chemicals in sanitary pads 12

2.1. Phthalates 14
2.2.1 Routes of exposure to phthalates 14
2.2.2 Impact of phthalates exposure on human health 14
2.2. Volatile organic compounds (VOCs) 16
2.3.1 Impact of VOC exposure on human health 16
2.3. Secondary studies highlighting presence of chemicals in sanitary products 20
2.4. improper disposal of sanitary products 22

3. Regulation on sanitary pads composition 24

3.1 Framework in India 26

4. Objective And Methodology 28

4.1 Sample collection 29
4.2 Methodology 30
4.3 Limitations 31

5. Result And Discussion 32

5.1 Phthalates in menstrual pads 33
5.1.1. Concentrations of phthalates in inorganic samples 33
5.1.2. Concentration of phthalates in organic pads 36
5.2 Concentration of VOCs in both inorganic and organic samples 38
5.2.1. VOCs in Inorganic pads 38
5.2.2. VOCs in organic pads 39

1
2
 BBP Butyl-benzyl phthalate

Abbreviations CAGR
CMR
DMP
Compound annual growth rate
Carcinogenic, mutagenic & reprotoxic
Di-methyl phthalate
DEP Diethyl phthalate
DnBP Di-n-butyl phthalate
DEHP Di (2-ethylhexyl) phthalate
DnOP Di-n-octyl phthalate
FDA Food and Drug Administration Agency
FHPs Feminine hygiene products
J&J Johnson & Johnson
P&G Procter & Gamble
PCPs Personal care products
SAP Super absorbent polymer
SDG Sustainable Development Goal
TCC Triclocarban
THF Tetrahydrofuran
USEPA United States Environmental Protection Agency
VOCs Volatile organic compounds

3
 Introduction
EVERY MONTH,
AROUND 1.8 BILLION
PEOPLE ACROSS THE
WORLD, INCLUDING
GIRLS, WOMEN,
TRANSGENDER
MEN AND NON-
BINARY PEOPLE, GO
THROUGH THEIR
PERIOD

4
Menstruation is a monthly process in which the lining of the
uterus sheds blood and tissue through the vagina. In common
parlance, this is often referred to as ‘period’. This cycle begins
when a girl reaches puberty (menarche), which is commonly
between 10 and 13 years of age, and continues until the end
of her fertility period (menopause), typically between 45-55
years of age. Every month, around 1.8 billion people across
the world, including girls, women, transgender men and non-
binary people, go through their period1. This monthly routine
usually lasts two to five days every time, but this varies
from person to person. A number of taboos are attached to a
natural and healthy process such as menstruation. Cultural
taboos, discriminatory social norms based on gender,
socio-economic status and lack of basic facilities such as
toilets and availability of clean water can all result in the
overlooking of menstrual health and hygiene needs.

5
 In 2016, Menstruators need safe menstrual products that help them in

sanitary pad carrying out their daily activities without physical limitations.
Though, historically, natural products were used during
sales in the menstruation, necessity and availability of new materials led to
country went the invention of new menstrual products. Currently, disposable
up to 5.12 sanitary pads are the most popular menstrual products worldwide.
billion pieces, Most menstruators use sanitary pads as a first-choice product for
which was an estimated average of 1,800 days in their lifetime.2 In recent

expected to years, among other changes, synthetic plastic materials have

been added to sanitary pads as liquid absorbent. This is meant to
grow to 10.31 enhance functioning and improve softness. Another addition to the
billion pieces by many commercially available sanitary pads is fragrance, in order
2021 to provide the user a feeling of freshness. Now there is a growing
concern that some of these chemicals, which are component of
sanitary pads, may affect user's health.

1.1 History of sanitary pads

Sanitary pads find a mention quite early on, dating back to 10th-
century Greece. But the very first disposable pads were created
by nurses because of the need to stop or control excessive
bleeding, mainly on the warfront. The first pads, made in France by
nurses, used wood pulp as the material was very absorbent, and
cheap enough to throw away afterward. This idea was taken up
by commercial manufacturers, who came up with disposable pads
in the late 1800s. In the early days, commercial disposable pads
were usually made of cotton wool or another fibrous material that
was coated with an absorbent liner. The front and back ends of the
liner were lengthened to fit through loops in a customised girdle or
belt worn beneath underwear. Since this type of pad would keep
shifting from its position, fastening adhesive was added to the

FIGURE 1: CHANGES IN SANITARY PRODUCTS

6
back sheet at around the 1970s. A major improvement was made with the addition of superabsorbent
gel particles in the absorbent core. It increased capacity and quick absorption of the menstrual
flow, providing more mobility and comfort to users. Even though sanitary pads have been available
commercially for a long time, most women couldn’t afford them for years. They continued to use
more traditional techniques. But over time, disposable sanitary pads have become commonplace
and are currently the most popular option.

1.2 Market share of sanitary pads

In India, the sanitary pad market has increased rapidly over the last two decades. In 2006, the
number of pads sold was close to 1.25 billion; with the number of sanitary pads sold doubling every
five years in India. In 2016, sanitary pad sales in the country went up to 5.12 billion pieces, which was
expected to grow to 10.31 billion pieces by 2021.3 However, no current data is available on the exact
number of pads sold in 2021.

In terms of value, in 2020, the size of Indian sanitary pads market was worth USD 521.5 million
approximately and this is expected to grow at a CAGR of 11.5% between 2021 and 2027 to reach
around USD 1,185 million by 2027. The Indian sanitary napkin market, currently, is dominated by
multinational giants P&G and J&J. According to a 2016 report by Euromonitor International, P&G’s
Whisper holds a market share of 50.4% in India in terms of sales, followed by J&J’s Stayfree at 23%
(with higher usage in rural areas) and Kimberly Clark Corp’s Kotex at 2.2 %.

FIGURE 2: THE INDIAN SANITARY MARKET FORECAST 2021-2027

INDIAN SANITARY
NAPKIN MARKET IN 2027
USD 1,185
Market forecast to grow
at a CAGR of 11.5%

MILLION

IN 2021
USD 618.4
MILLION

7
 1.3 Composition of sanitary pads
Since the time of inception, sanitary pads have undergone several changes. Early sanitary pads
were made mostly of flannel or woven fabric. Then came the sanitary pads made with gauze and
cotton. Later, the sanitary pads began to be manufactured using cellulose, which had a higher
absorption power than cotton pads. These superabsorbent pads underwent further modification in
the form. First came the belt pad, which was soon replaced by the beltless pad with adhesives. More
recent additions to the sanitary pads include fragrance.

The plastic upsurge, in last few decades, changed the way sanitary napkins are designed and made.
Over the years, the plastic content of a sanitary pad has increased multifold, right from the use in
top sheet and back sheet to avoid leakage, to individual packaging of each sanitary pad in order to
provide discreteness. Use of Super absorbent polymer (SAP) and polyethylene for back cover made
the napkins waterproof and use of polypropylene in top sheets helped keep the sanitary pad dry.

Nowadays, a typical sanitary pad can be divided into four key layers, with additional packaging
plastic pouch:

Fluid permeable top sheet,

Acquisition layer or the Transfer layer,
Absorbent core, and
Impermeable backing containing glue (back sheet)

In addition to these, there are adhesives, paper releases, etc.

FIGURE 3: LAYERS OF PLASTIC PADS

TOP LAYER
Perforated plastic sheet (PP. PE)
SYNTHETIC CHEMICALS
Artificial perfumes, Heavy metal
dyes
TRANSFER LAYER
Synthetic fibers or
Cellulose based pulp
ABSORBENT CORE
Sodium polyacrylate (SAP)
derived from crude oil
ADHESIVE
Hot melt glue
BOTTOM LAYER
Polyethylene (PE)
Petrochemical based
RELEASE PAPER
Silicone coated paper

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Fluid permeable top sheet: It is mostly made up of a thin layer of perforated polypropylene and /
or polyethylene. Being the first layer, this comes in direct contact with the skin, and its major function
is transference of the gathered fluid to the layers underneath. In most commercial pads, this layer is
coated with emollient and lotion, in order to prevent skin irritation and also provide softness4.

Acquisition layer: Its primary function is to spread the fluid evenly and is composed of non-woven
polyester and a cellulose patch. It also helps to transfer the fluid to the next absorbent layer.

Absorbent core: This layer acts as the main storage area for the fluid. The composition is a mix of
fluff cellulose and SAP, which contain non-woven polypropylene or cellulose. SAP is made up of
sodium polyacrylate granules, which turns into a gel-like substance once wet, and is capable of
holding liquid more than 30 times its weight. The job of the cellulose fluff is to absorb the fluid quickly
and transfer it to the SAP.

Impermeable backing containing glue (back sheet): The main function of this layer, composed of
waterproof polyethylene or polypropylene laminated with non-woven polypropylene, is to prevent
the fluid from leaking. Since this is the last layer, it contains adhesives to keep it fixed on cloth.

The emollient and the top sheet are in direct contact with the skin; hence it is likely that the
chemicals present in this layer are directly absorbed by the skin. The acquisition layer and super
absorbent layer, while not in direct contact, may have indirect interaction with the skin and lead to
the absorption of chemicals. The back sheet and adhesives cause little or no exposure as they are
farthest from direct skin contact (Figure 3).

FIGURE 4: EXPOSURE RISK OF DIFFERENT LAYERS OF DISPOSABLE PADS

Skin

Emollient top sheet

Acquisition layer (cellulose/

polyester)

Super absorbent encapsulated

with a non-woven

Back sheet adhesive

9
 Percentage wise, the chemical composition of sanitary pads contains the following items:

FIGURE 5: COMPOSITION OF A TYPICAL SANITARY PAD

Fluff
48%
Release
Paper 3 %
PE, PP & PT 36%

Superabsorbent
6% Adhesives 7%

1.4 Menstrual Products &

Sustainable Development Goals
As per the Brundtland Commission, sustainable development has been defined as “development
that meets the needs of the present without compromising the ability of future generations to meet
their own needs”. In 2015, the United Nations (UN) adopted Sustainable Development Goals (SDGs),
also known as global goals, to achieve this end. This is a global call for action, with the primary
aim of ending poverty, protecting the planet and ensuring that there is peace and prosperity across
board by 2030.

Considering period poverty under SDGs, the UN, in 2018,

reported that incorrect information coupled with the stigma
that surrounds menstruation can lead to serious health and
human rights concerns. It therefore declared menstrual
hygiene as an issue that affects gender equality, human
rights and public health, leading to its addition to the 2030
agenda. This can help in sustainable social and economic
development that can eradicate poverty, hunger and lack
of access to healthcare. The issues associated with period
poverty connect to SDG 1 (no poverty), SDG 3 (good health
and well-being), SDG 4 (quality education), SDG 5 (gender
equality) and SDG 6 (clean water and sanitation), though it is
also connected to other SDGs such as 11, 12, 14 and 15.

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Access to clean menstrual products is crucial to the
eradication of period poverty; it is the focus area of several
menstrual hygiene programs. But SDG 3 clearly highlights
good health, hence one needs to look beyond just access to
sanitary products for young girls and women, and highlight
the need for access to products free of toxic chemicals.

SDG 12 of ‘ensure sustainable production & consumption’, if

applied to menstrual products, would mean producing and
consuming menstrual management products which are free
of toxins and single-use plastic content, It would thus bring
menstrual products into the ambit of circular economy.

11
12
Toxic
chemicals in
sanitary Pads
Most of the commercially available sanitary pads have plastic as the main
constituent; at almost 90%. Being non-biodegradable, plastic has huge environmental
consequences, but the chemicals, added intentionally or present due to the processes
used in the manufacture of a sanitary pad, are also a cause of concern. Sanitary pads
include various chemicals which are added by manufacturers to improve presentation,
functionality and consumer acceptance.

The major chemicals added during the entire cycle from manufacturer to packaging include:
a. Plastics and plasticisers: Synthetic plastic have been used in sanitary pads and diapers as
liquid absorbents to improve functionality and softness5. According to health experts,6 ‘plastic
in sanitary pads disturbs the balance of the vaginal microflora and can cause health problems
including but not limited to uro-genital tract infection, rashes’. SAP, which are added to the
absorbent core in almost all commercially available sanitary pads, are also believed to have
negative effects on the health of users. Prolonged contact has been linked to skin reactions
such as rash and even toxic shock syndrome. Other plasticisers of concern include bisphenols,
parabens and triclocarban (TCC). Parabens are antimicrobials that are used as preservatives in
feminine care products, whereas TCC is an antibacterial agent. Most of these added plasticisers
are widely considered to be ‘endocrine disrupting chemicals’ that are known to have a negative
effect on female reproductive health.7 Exposure to parabens is linked to breast cancer while
Bisphenol A (BPA) is linked to reducing the viability of germ cells involved in reproduction.
b. Fragrance ingredients: VOCs are added as fragrances, adsorbents, adhesives, moisture
barriers and binders in feminine hygiene products. VOCs are linked to negative health effects
such as endocrine disruption, infertility, birth defects and cancer.

Apart from these, some chemicals get added unintentionally as a result of processes involved in
manufacturing,
Dioxins & furans: Chlorine is used as bleaching agent for the fibres in pads in order to give them
a clean and sterile appearance. Dioxins and furans get added as a by-product of the bleaching
process of cotton.
Pesticide residue: Pesticide residue is common in cotton sanitary pads.
Genetically modified organisms (GMOs): The United States Department of Agriculture (USDA)
states that around 94% of all cotton in the United States (US) is genetically engineered.8

In recent years, global studies have highlighted the presence of various toxic chemicals in sanitary
pads, which may potentially harm users.

As mentioned above, sanitary pads sold commercially are designed in a way that puts some of
the layers in direct contact with the vaginal area. The structure of the vulvar and vaginal tissues
is different from the skin of the rest of the body; being more permeable and covered in mucous

13
 membranes, it allows for the direct transfer of chemicals into the circulatory system. Studies show
that while rapid absorption can work well for delivering a drug rapidly, it may also expose women to
higher levels of chemicals from feminine hygiene products as the area of contact has a direct route
to reproductive organs.

2.1 Phthalates
Phthalates or phthalic acid esters (PAES) are terms that refer to diesters of 1,2-benzenedicarboxylic
acid (phthalic acid). Phthalates have been used as plasticisers to make the material softer and more
flexible, increase plasticity, reduce viscosity, or reduce friction during manufacturing. Phthalates
are used in various plastics since the 1930s, with DEHP (a major phthalate used in sanitary pads)
accounting for a fifth of all plasticisers ever developed. The global production of phthalates went up
from 2.4 million tonnes to 6 million tonnes between 2007 and 2017.9

Phthalates are generally added in the layers of sanitary pads to enhance the elasticity and gel
properties.10 Phthalates is also used in hot-melt adhesive, which is used to join different layers of
sanitary pads.

Phthalates have become a pervasive environmental problem as a result of their widespread use
in numerous industries. Phthalates are emitted or migrate throughout the whole life cycle of a
phthalate-containing product, from manufacturing to consumption. Rising concern over the presence
of phthalates in significant quantities in the environment and the possible toxic impact has led the
United States Environmental Protection Agency (USEPA) to declare six phthalates, namely di-methyl
phthalate (DMP), diethyl phthalate (DEP), di-n-butyl phthalate (DnBP), di (2-ethylhexyl) phthalate
(DEHP), di-n-octyl phthalate (DNOP) and butyl-benzyl phthalate (BBP), as priority pollutants.11

2.2.1 ROUTES OF EXPOSURE TO PHTHALATES

Humans can get exposed to phthalates on a daily basis through ingestion, inhalation, intravenous
injection and dermal contact. Most women use sanitary pads for several decades of their life, with
girls starting the use at an age when their bodies are still developing and are much more vulnerable
to exposures to chemicals.12,13 Sanitary pads come into direct contact with the vulva, and the mucous
membranes, as stated above, are capable of rapidly absorbing these chemicals without breaking
them down.14

2.2.2 IMPACT OF PHTHALATES EXPOSURE ON HUMAN HEALTH

Since the beginning of the previous decade, information on the impact of phthalates on reproductive
health, developmental health and other health issues has been building. Many epidemiological
studies link phthalate exposure and female health. Some of the most important epidemiological
research, which is required to comprehend the need of implementing effective remediation
measures, is presented below:

14
Female reproductive health

Study has shown linkage between urinary levels of phthalate, along with other chemicals, with
early onset of puberty in girls.15 Similarly, another study16 has shown that an early menarche and
fast breast development among young girls is linked with exposure to phthalates such as DEHP,
DEP, DMP, and DnBP. Another case-control study conducted in Northern Mexico found a strong
link between environmental exposure to phthalates and development of female breast cancer.17
Some other studies have found high plasma concentrations of phthalates in females suffering from
endometriosis.18,19

Pregnancy and foetal development

The negative impact of phthalates on pregnant and breastfeeding women would affect their babies,
in addition to their own health; thus, it is important that this vulnerable population gets focused
attention. Some studies establish the association between phthalate exposure during pregnancy
(specifically DEHP, DBP and DEP) and pregnancy-related complications including preterm birth.20,21
Studies also show that exposure to phthalates during pregnancy may have an adverse effect on
diastolic blood pressure, thereby increasing the risk of pregnancy-induced hypertensive diseases.22
Gestational phthalate exposure is also supposed to affect foetal development. In Japan, maternal
blood MEHP levels are said to be associated with reduced levels of testosterone (T)/estradiol (E2),
progesterone (P4), inhibin B and insulin-like factor 3 in male cord blood,23 indicating the impact of
phthalate exposure. A study24 states that most phthalates disturb the expression of various genes
and can cause reproductive tract anomalies in male neonates. A study also highlights a possible
linkage between development of asthma in children and early-age exposure to phthalates.

Effects on cardiovascular system

Exposure to phthalates is associated with cardiovascular risks such as blood pressure problems,
atherosclerosis and coronary heart disease.25 A study26 of 1,016 subjects aged 70 years found the
four phthalates of MMP, MEHP, MiBP and MEP generally linked with coronary heart disease among
the old.

To summarise, exposure to phthalates can have the following health effects:

Early onset of puberty in girls including menarche and accelerated breast development
Endometriosis
Pregnancy-related complications, including preterm birth and pregnancy-induced hypertension
Issues with foetal development
Male reproductive tract anomalies
Blood pressure issues

15
 Atherosclerosis
Coronary heart disease
Insulin resistance

2.2 Volatile Organic Compounds (VOCs)

Volatile organic compounds, also known as VOCs, are compounds that have a low water solubility
and high vapour pressure, which is released in the form of gas from certain solids or liquids. VOCs
are used as ingredients in products such as paints, deodorants, air fresheners, nail polish, moth
repellents, fuels and automotive products. Some VOCs that adversely impact human health include
benzene, styrene, 1-4, dioxane chlorobenzene and acetone.

In sanitary pads, VOCs are mainly added as fragrances, adsorbents, moisture barriers, adhesives
and binders. VOCs may also be unintentionally present in the raw material or packaging material.

2.3.1 IMPACT OF VOLATILE ORGANIC COMPOUNDS (VOCs)

EXPOSURE ON HUMAN HEALTH
VOCs have the potential to be inhaled through the human respiratory system due to their volatility.
VOCs such as xylene and benzene have been linked with harmful neurologic effects on the brain,27,28
whereas chloroform, 2-ethylhexanol, phenol, ethylbenzene and toluene cause adverse effects,
including paralysis, memory loss, loss of appetite and tiredness.29,30

Furthermore, most VOCs have a low molecular weight and are hydrophobic, allowing them to pass
through the skin easily,31 causing major side-effects such as skin inflammation and protein oxidative
damage in keratinocytes. The impact of VOCs on health came into light after a feature in the south
Korean media in 2017, which wrote about a lawsuit filed by thousands of women against a South
Korean firm. This was after some civic groups had found harmful chemicals in sanitary pads and also
many women had reported health problems after using them. A women’s health advocacy group,
Korean Women’s Environmental Network, released a survey on 3,009 women who responded about
experiencing abnormal symptoms after using a particular brand of pads. This later led to removal
of the pads from the market. Numerous side-effects such as vaginal infection, not having menstrual
cycle and irregular menstrual cycle changes were seen in Korean women who used disposable
sanitary pads.

The detailed health impact of different types of VOCs on human health is summarised in the table
below.

16
TABLE 6: IMPACT OF VOCs ON HUMAN HEALTH

S. No Name Health Impact

1 Acetone Nephrotoxicity
2 Dichloromethane Exposure to high concentrations may cause unconsciousness and death.
3 N- Hexane Exposure to n-hexane can cause toxicity in peripheral nerves, muscle
wasting and atrophy.
4 Chloroform Exposure to high concentrations may cause convulsions, coma and death
due to respiratory failure or cardiac arrhythmia.
5 Tetrahydrofuran Cause headaches, nausea and dizziness. Very high exposure can lead to
unconsciousness and death.
6 Benzene Harm the bone marrow and lead to a dip in red blood cells, causing
anaemia.
7 Toluene Cause eye and nose irritation, tiredness, confusion, euphoria, dizziness,
headache, dilated pupils, tears, anxiety, muscle fatigue, insomnia, nerve
damage, inflammation of the skin, and liver and kidney damage.
8 Cyclohexane Cause headaches, sleepiness, dizziness, limb weakness, motor changes
and verbal memory impairment.
9 Styrene Chronic (long-term) exposure to styrene affects the central nervous
system (CNS), leading to headache, fatigue, weakness, depression, CNS
dysfunction, hearing loss and peripheral neuropathy.
10 M-Xylene Can irritate the eyes, nose, skin and throat. Xylene can also cause
11 P-Xylene headaches, dizziness, confusion, loss of muscle coordination and, in high
12 O-Xylene doses, death.
Can cause defatting of the skin with irritation, dryness, erythema and
cracking. Blistering may occur if exposure to concentrated xylene is
prolonged.
Long-term exposure may also lead to headaches, irritability, depression,
insomnia, agitation, extreme tiredness, tremors, impaired concentration
and short-term memory loss.
13 Trichloroethylene Acute (short-term) and chronic (long-term) inhalation exposure to
trichloroethylene can affect the human central nervous system (CNS),
with symptoms such as dizziness, headaches, confusion, euphoria, facial
numbness and weakness.
14 Penta chloroethane Can cause headache, nausea, vomiting, abdominal pain, diarrhoea,
dizziness, confusion, tremors, drowsiness, seizures and even death.
15 Cyclohexanone Can cause headaches, dizziness, lightheadedness and unconsciousness.

17
 S. No Name Health Impact
16 Phenol Dermal exposure to phenol causes inflammation, erythema, discolouration
of the skin, burns and necrosis.
Exposure to phenol may also irritate the skin, eyes, nose, throat and
nervous system. Some symptoms of phenol exposure are weight loss,
weakness, exhaustion, muscle aches and pain.
17 N, N-Dimethylacet- Acute toxic dermal and inhalation exposure has resulted in severe hepatitis,
amide rhabdomyolysis, hallucinations and coagulopathy
18 Carbon The primary effects of carbon tetrachloride in humans are on the liver,
tetrachloride kidneys and CNS. Symptoms of acute (short-term) inhalation and oral
exposures to carbon tetrachloride include headache, weakness, lethargy,
nausea and vomiting.

19 1, 2, 3 Can damage the liver and kidneys.

Trichloropropane
20 1, 1, 2- The only effect that has been noted is stinging and burning sensations of
trichloroethane the skin upon dermal exposure.
21 Trans-Di-1, It can irritate the eyes and the respiratory system, and ultimately CNS
2-chloroethane depression.
22 Cis- Immunological, neurological, reproductive, developmental, genotoxic and
dichloroethylene carcinogenic effects.
23 1, 2 -Dichloroethane Irritates the eyes, nose and throat. It may cause eye problems, headache,
feeling of drunkenness, fatigue, CNS depression, convulsions, pulmonary
oedema (excessive fluid in the lungs), unconsciousness and death from
respiratory and cardiac failure.
24 1, 1, Irritates skin and eyes. Inhalation or ingestion can lead to headache,
1-Trichloroethane dizziness, lack of coordination, stupor, coma, CNS and respiratory
depression, and cardiac dysrhythmia.
25 1, 1, 1, 2- Skin and eye Irritation.
Tetrachloroethane

18
To summarise,
VOCs can have
the following
health impacts

Paralysis of
the CNS

Memory loss

Loss of
appetite

Tiredness

Menstrual
cycle issues

19
 2.3 Secondary studies highlighting presence of
chemicals in sanitary products
In a study32 done in the US, the presence of phthalates, parabens, bisphenols and TCC were found
in feminine hygiene products, indicating a big source of EDC exposure for women. The study tested
seven types of feminine hygiene products including pads, tampons, panty liners, wipes, bactericidal
creams and solutions, and deodorant sprays and powders for 24 EDCs. Another study,33 done in
2009 in South Korea, sought to check the presence of heavy metals in sanitary pads. On testing,
toxic metals such as cadmium, chromium, copper, cobalt, nickel and lead were found.

Some studies have been done to check the presence of VOCs in

VULVAR SKIN
sanitary pads. In 2014, Women’s Voices for Earth reported that a well- AND VAGINAL
known brand of sanitary pads contained styrene, chloromethane and MUCOSA HAVE
chloroform.34 A similar study35 done on 10 different types of sanitary HIGH ABSORPTION
EFFICIENCY AND
pads in South Korea tested and found over 200 VOCs including PERMEABILITY
benzene, styrene and trichloroethylene. It is also important to note that AND HENCE THE
most of these VOCs are hepatotoxic and nephrotoxic in nature. CHEMICALS PRESENT
IN FEMININE HYGIENE
A study 36conducted in Denmark among girls under 19 years of age PRODUCTS CAN BE
EASILY ABSORBED
investigated the effects of MEP, MBP, DEHP and DINP metabolites in
urine, and discovered that younger girls with less advanced pubertal development had the highest
first-morning urinary concentration of MBP, MBzP, DEHP, and DINP phthalates. Another study37
reported the concentrations of several phthalates (DEP, DBP and DEHP) in sanitary pads from six
countries (Korea, Japan, Finland, France, Greece and the US). Overall, phthalates in significant
quantities were found in all 11 brands used for the study. VOCs, too, were found in significant
quantities in most of the same 11 brands. The presence of phthalates has also been observed in
sanitary pads in studies done in countries such as the US38, Canada,39 China,40 and Korea.41

The Korean Women’s Environmental Network found 84 VOCs in sanitary pads.42 As mentioned in the
earlier section, close to 3,000 women in Korea disclosed having suffered from many reproductive
health issues after using sanitary pads of the same brand.

Study has shown 10-fold higher serum estradiol levels due to vaginal application of estradiol when
compared to oral dosing. This indicates that there might be greater health risks from this exposure
route, which would mean that chemicals present in sanitary pads might get absorbed at a much
faster pace through the vaginal route. Even then, few studies have investigated sanitary pads as a
source of chemical exposure in the vagina and vulva.43

20
The table below compiles some studies done globally to assess harmful chemicals in sanitary
products.

TABLE 1: CHEMICALS IN MENSTRUAL HYGIENE PRODUCTS

Significant studies conducted globally Findings Year Ref.

US-based study examined dioxin levels in All tampons showed presence of 2002 44

four different brands of tampons. polychlorinated dibenzo-p-dioxins and

dibenzofurans, with total concentration
ranging from 1.5 to 23.6 pg/g.
US-based organisation - Women’s Voices Detected 20 different types of VOCs in the 2014 45

for the Earth -- tested four types of sanitary pads, with concentrations in the
menstrual pads. range of 0.52-480 ppbv.
The Conscious Consumers Association of All products contained phthalates, 2014 46

Indonesia tested five popular tampons and parabens and triclosan.

four types of pads.
Indonesian Consumers Foundation (YLKI) Found chlorine in all pads, with highest 2015 47

tested Indonesia-based sanitary pads. concentration of 5,793 PPM.

Swiss study tested sanitary towels. Found phthalates and formaldehydes. 2016 48

The Korean Women’s Environmental Found over 200 VOCs, including benzene, 2017 46

Network tested 10 different sanitary pads. styrene and trichloroethylene.

The Ministry of Food and Drug Safety of VOCs were detected in most products, 2017 49

South Korea tested 666 sanitary pads/ though at a level much lower than the
panty liner products in South Korea for safety margin.
VOCs

The Voice for Women tested six popular 8 VOCs were found in the range of 0.5 to 2018 50

brands of US tampons. 029 ppbv.

Sanitary pads were tested for 74 VOCs in 50 VOCs were found in sanitary pads 2019 51

Korea retailed in Korea at concentrations ranging

from 0.025 to 3548.09 µg/pad.
26 sanitary samples from six different DMP, DEP, DiBP, DnBP, BMPP and DEHP 2019 52

countries were analysed to assess the were detected in all samples. Fifteen
presence of phthalates. phthalates with concentration range (0.68-
7152 PPb) measured.

21
 Significant studies conducted globally Findings Year Ref.
US-based study of 11 sanitary pads from Presence of phthalates and VOCs were 2019 53

Korea, Japan, Finland, France, Greece and detected. The total concentration of
the US. phthalates was found in a range of 9.8-
7820 PPb.

Belgium-based study Desmedt reported The results show that five allergenic 2019 54

a total of 10 samples analysed for the fragrance ingredients were present in

presence of VOCs. concentrations <10 µg/g.
A study conducted in China on 120 Showed the presence of eight phthalates. 2020 55

feminine hygiene products (56 feminine Phthalates were found in 86% and 98%
care products and 64 sanitary napkins). of feminine care products and sanitary
napkins, respectively - Diethyl phthalate,
dibutyl phthalate, and bis(2-ethylhexyl)
phthalate were the major compounds.

43 feminine hygiene products such as 24 EDCs, comprising nine phthalates 2020 33

pads, panty liners and tampons tested in (205-11200 ng/g), six parabens (0.04-1700
and around Albany, New York, US ng/g), eight bisphenols (LOD- 104 ng/g),
and triclocarban (LOD- 0.47 ng/g), were
detected.

A study conducted in the US, Ding et al., Showed the presence of VOCs (2-butanone 2021 56

tested sanitary pads and tampons to and methyl isobutyl ketone) in urine during
analyse the presence of VOCs. the menstrual period.

2.4 Improper disposal of sanitary products

In many countries around the world, proper disposal of used menstrual products is still inadequate.
Due to a global lack of menstruation management practices, most women dispose of their sanitary
pads or other period products in solid waste or rubbish bins at home, which eventually form part
of solid wastes. In India, 12 billion sanitary pads are used every year, with a large percentage of
it ending up in landfill sites or waterbodies. When sanitary pads enter landfills or pits, hazardous
and toxic chemicals seep into the soil. Some of the chemicals from menstrual waste may lead to
toxic emission, groundwater pollution and loss of soil fertility, and also microplastic pollution. The
plastic containing pads can take up to 500 years to break down, release toxic chemicals into the
environment over a period of time along with generating microplastics that threaten our ecosystem.

22
The World Health Organization (WHO) recommends that health-related trash be burned at high
temperatures (over 800°C) to transform it into comparatively innocuous gas and incombustible solid
waste, such as ash,57 which can then be disposed of in authorised ash pits or controlled landfills.
However, burning sanitary waste at low temperatures (via local incinerators, open burning, etc.)
may further increase the problem. Due to the presence of high amounts of plasticisers as well as
bleached cotton there is an ever-increasing risk of the emission of noxious, toxic gas. Furthermore,
these harmful gases can travel a long distance from the place of emission, thus impacting not only
the health of the population residing near these places, but in far and wide areas as well.

23
24
Regulation on
the composition
of sanitary pads
In the US, sanitary pads are classified under FDA Class I medical devices. Under this, manufacturers
are advised to look at new compositions in terms of materials and also identify new bleaching
processes or technology used during manufacturing. These regulations, however, are not legally
binding and are considered as guidelines or recommendations. FDA recommends that details of
quantities of all composition materials may be provided. This is again recommendatory in nature. But
from 2020, New York State requires disclosure of FHP ingredients, the first such requirement of its
kind in the US.58

In June 2021, the EU passed a new resolution, urging member states to encourage wide availability
of toxin-free and reusable menstrual products. REACH (Registration, Evaluation, Authorization and
Restriction of Chemicals), the EU regulation that applies to all consumer products placed in the EU
market, restricts the use of phthalate that is included in the list of carcinogenic, mutagenic or toxic
to reproduction (CMR) substances of category 1A, 1B or 2 under the Classification, Labelling and
Packaging (CLP) Regulation, including: BBP, DBP, DEHP, DIBP. The above phthalates are restricted
to a maximum content of 0.1% by weight of the plasticised material in the article (individually or in
combination).

25
 In Korea, sanitary pads are regulated under Quasi-Drugs by the Korean Ministry of Food and Drug
Safety (MFDS). Fluorescent whitening agents, formaldehyde, chlorinated phenols (pentachlorophenol
and tetrachlorophenol), azoic dyes, phthalates, and metal pollutants (antimony, barium, cadmium,
chrome, lead, mercury, arsenic, selenium, etc.) are all prohibited by the regulations and laws in the
country.

In China, safety of sanitary pads is regulated under GB 15979-2002. It is a mandatory regulation

by which manufacturers should provide microbial and toxicological indicators along with pH
value, infiltration capacity and water absorbency, but there are no regulations on the presence or
concentrations of phthalates and VOCs.

In France, the manufacture, composition and use are not governed by any regulation but are
subject to horizontal legislation including the general product safety directive (GPSD). The horizontal
legislation deals with environmental legislation on various matters which cut across diverse
environmental subject areas, as opposed to regulations for a specific area sector, e.g. water or
air. Rather than regulating a specific area, these items of legislation are more procedural. In July
2018, the French Agency for Food, Environmental and Occupational Health and Safety (ANSES)
evaluated traces of fragrances, polycyclic aromatic hydrocarbons (PAHs) and pesticides in feminine
hygiene products that were carcinogenic, mutagenic or reprotoxic (CMR), endocrine-disrupting or
skin-sensitising. Some of the pesticides banned in the EU were also found in the products. Thus, the
agency called for restrictions and urged manufacturers to improve quality for raw material.

The Australian government regulation (2019) AS 2869:2008 does have some regulations on
manufacturing of tampons to minimise risk to health associated with the use of such products.
However, chemical compositions and quantity does not form a part of this guideline. Also, other
menstrual products are not included.

3.1 Framework in
India
In India, there are no clear regulations
on chemical content in sanitary pads
for manufacturers. The Bureau of Indian
Standards 1980 specifies very basic
tests to determine absorbent fillers
surface and pad texture. However, there
is no requirement to test the toxicity of
ingredients.

26
Sanitary pad manufacturing companies are not required by law to state ingredients on the packet as
they are labelled as ‘medical products’, thus exempted from the ingredient-listing.

REGULATION FOR DISPOSAL OF SANITARY WASTE IN INDIA

Since most commercially available sanitary pads are laden with chemicals, the impact on health and
environment post disposal cannot be ignored. Sanitary waste in India is classified under Solid Waste
Rules, not biomedical waste. As a result of this classification, the majority of sanitary waste ends up
in landfills.

Furthermore, even the new guidelines to address the issue released in 2018 mostly suggested local
incineration as a viable means to divert this waste from going into landfill. Here, it is important to note
that most low-cost incinerators (both at urban and local level) do not conform to stated guidelines,
thereby not incinerating the sanitary waste at the required high temperatures. This in turn increases
the risk of these chemicals being released into the environment as a result of incomplete burning.
Some studies indicate the incineration of household waste as a source of VOCs being released in
the environment.59

27
28
Objective and
Methodology
India is a huge market for sanitary products, and the market for sanitary pads has been growing
exponentially. Over the past few years, some studies done in Europe, US and other countries
have reported presence of chemicals such as phthalates and VOCs in menstrual products, raising
questions and concerns about the impact on the health of the users. But in a country like India,
where even the usage of sanitary pads is yet to be universalised, there is little or no information on
ingredients or presence of toxic chemicals in the products sold or available in the market.

Hence, the purpose of this study is to determine presence of phthalates and VOCs, commonly found
chemicals, in menstrual products in the country and to influence policy and management actions to
limit these.

The specific objective:

Qualitative and quantitative analysis of phthalates in sanitary pads

Qualitative and quantitative analysis of VOCs in sanitary pads

Create awareness among women about the impact of phthalates and VOCs on their health

4.1 Sample collection

A total of 10 menstrual products were procured from markets in New Delhi, India as well as online
portals. Both organic and inorganic sanitary pads samples were included in the qualitative and
quantitative analysis. The number of inorganic pads included in the study is more, given their wide
usage. Pads from popular brands with varying prices were taken. Detailed information on sanitary
products analysed in this study is summarised in Table 2. The samples were labelled and listed
before being dispatched to the testing institute.

FIGURE 2: PICTURES OF ALL SANITARY PAD SAMPLES

29
 TABLE 2: DETAILS OF SAMPLES

Sample details
CODE Inorganic samples CODE Organic samples
ISP1 Whisper Ultra clean OSP1 PEE Safe 100% organic cotton biodegradable
ISP2 Stayfree Dry Max OSP2 AZAH Organic Pad
ISP3 Sofy Anti-bacterial OSP3 Plush 100% Pure US Cotton
ISP4 Nine Dry Comfort OSP4 NUA Light Flow
ISP5 Bella Regular Drai Wings
ISP6 Evereve Ultra sanitary napkins

4.2 Methodology
SAMPLE PREPARATION
To measure phthalate contents, a single pad from each pack was weighed before sample collection.
Samples of small pieces (size and length 4 mm) were collected using clean scissors from four
different locations of each pad. Samples were weighed and transferred to the 20 ml reaction vessel.
Five ml of THF + 20 mg/l IS was added and the cap was sealed tightly and sonicated at 60 ± 5°C for
60 minutes ± 5 minutes after the sonication, the solution was cooled down to room temperature and
10ml n-hexane with 10 mg/l IS added for polymer precipitation. The solution was properly mixed using
vortex for 30 seconds and made to stand still for 30 ±5 minutes. Finally, the solution was centrifuged
at 700 G for 10 minutes and filtered through 0.45µ PTFE membrane filter. All the samples were then
analysed using gas chromatographic and mass spectrometric to analyze phthalates.

MEASUREMENT OF PHTHALATES
Gas and mass chromatograph equipped with a DB-5ms (30 m x 250 μm x 0.25 μm) column was used
for the analysis of phthalates. In the instrument, helium gas was used as a carrier gas during the
analysis. Flow rate of the solution was 1 mL/min.

MEASUREMENT OF VOCs
All the sanitary pad samples were analysed for VOCs using the HS-GC-MS. Sample analyses
followed well-developed protocols. Chromatographic separation was performed using DB-WAX
(30 m x 250 µm x 0.25 µm) with helium as the carrier gas, and a temperature program that started
at 40°C (3 minutes), ramped at 7°C/minute to 150°C (1 minute), and finally ramped at 60°C/minute to
240°C. To measure the VOCs, an uncut sample was placed 1g±0.1g into a headspace vial and sealed;
then the sample was incubated at 90°C±2°C for 20 minutes±2 minutes. Finally, the samples were
analyzed using HS-GC-MS.

30
4.3 Limitations
Due to the operational limitations of GCMS and HPLC, low concentrations of phthalates and VOCs
could not be detected. Extensive range GCMS and HPLC for the analysis of low concentrations of
phathalates and VOCs were not available during the study.

31
32
Result and
Discussion
There are different kinds of menstrual products available in the market. For this study, sanitary
pads -- both inorganic and organic -- were assessed for the presence of phthalates and VOCs. As
mentioned in the methodology, a total of 10 samples, six inorganic sanitary pads (ISP1-ISP6) and four
organic sanitary pads (OSP1-OSP4), were sent for testing. During testing, the results for VOCs and
phthalates were analysed weight-wise (μg/kg). This was then converted to pad=wise concentrations.
The average weight of a pad was taken to be around 10 grams.

Among phthalates, the maximum concentration was of DIDP at 190 μg/pad in Plush 100% Pure US
Cotton, an organic pad. The highest concentration of VOC was of acetone (6.9 μg/pad), detected in
Bella Regular Drai Wings.

5.1 Phthalates in menstrual pads

The menstrual pads were tested for phthalates such as DIBP, DBP, DINP, DIDP, DMP, DEP, BBP,
DNOP, DEHP, DHP, DIPP and DPP. All products included in the study tested positive for presence
of phthalates. The total concentration of phthalates detected were in the range of 10- 19460 μg/kg.
DIBP and DEHP were the only two phthalates found in all the samples.

5.1.1 CONCENTRATIONS OF PHTHALATES IN INORGANIC SAMPLES

All the six inorganic menstrual pads tested showed presence of phthalates. A total of 12 different
types of phthalates namely, Di-isobutyl phthalate (DIBP), Di-butyl phthalate (DBP), Di-isononyl
phthalate (DINP), Di-isodecyl phthalate (DIDP), Di-methyl phthalate (DMP), Di-ethyl phthalate (DEP),
Benzyl butyl phthalate (BBP), Di-n-octylphthalate (DNOP), Di(2-ethylhexyl) phthlate (DEHP), Di-
heptyl phthalate (DHP), Di-isopentyl phthalate (DIPP), and Di-pentyl phthalate (DPP) were found in
the inorganic sanitary pad samples. The total concentration of phthalates was found in the range of
10–10230 µg/kg. The sample from Bella Regular Drai Wings (ISP5) showed the presence of
all 12 different types of phthalates (DIBP, DBP, DINP, DIDP, DMP, DEP, BBP, DNOP, DEHP, DHP, DIPP
and DPP). Among all the phthalates present in Whisper Ultra Clean, DIBP was found to be at the
highest concentration of 2350 µg/kg.  

Sofy Anti-bacterial (ISP3) showed the presence of 10 different types of phthalates (DIBP, DBP, DINP,
DIDP, DEP, BBP, DEHP, DHP, DIPP and DPP), with DEP having the greatest concentration at 10230 µg/
kg and DHP having the lowest concentration at 260 µg/kg among the 10 phthalates in ISP3. Whisper
Ultra Clean (ISP1), one of the most used brands in the country, showed presence of six different
types of phthalates (DIBP, DBP, DEP, DEHP, DHP and DIPP) with concentrations of 2350, 1690, 840,
330, 170 and 120 µg/kg. Evereve Ultra sanitary pad (ISP6) showed the maximum concentration of
DEHP at 1180, followed by 470, 460, 370, 340, 340 and 10 µg/kg of DBP, DIBP, BBP, DEP, DPP and
DMP respectively. The toxic effects of some of these phthalates, experimentally observed in various
species,60 concern the endocrine system.

33
 Stayfree Dry Max (ISP2) sample tested in the study showed the highest concentration of DEHP
at 2450, followed by 1810, 500, 460, 430, 370, 220, 80 and 30 μg/kg of BBP, DIBP, DEP, DIPP, DPP
and DMP as reported in Figure1 (A – F). Nine Dry Comfort (ISP4) showed the presence of all 12
phthalates with the highest concentration of 3680 μg/kg of DIBP and 10 μg/kg of DMP as the lowest
concentration. Studies have found that low molecular phthalates such as DEP can acutely irritate the
skin, conjunctiva and the mucous membrane of the oral and nasal cavities. 

FIGURE1 (A – F): PRESENCE OF PHTHALATES IN THE 10 SAMPLES TESTED IN THE STUDY

6000

5000

4000

3000

2000

1000

0
Whisper Ultra Stayfree Dry Max Sofy An�-bacterial Nine Dry Comfort Bella Regular Drai Evereve Ultra
clean Wing’s sanitary napkin’s
DIBP DBP DINP DIDP DMP DEP BBP DNOP DEHP DHP DIPP DPP

ISP1 ISP2
A B
Whisper Ultra clean

Stayfree Dry Max

0 500 1000 1500 2000 2500 0 500 1000 1500 2000 2500 3000

DPP DIPP DHP DEHP DNOP BBP DPP DIPP DHP DEHP DNOP BBP

DEP DMP DIDP DINP DBP DIBP DEP DMP DIDP DINP DBP DIBP

34
 ISP3 ISP4
C D
Sofy Antibacterial

Nine Dry Comfort

0 2000 4000 6000 8000 10000 12000
0 1000 2000 3000 4000
DPP DIPP DHP DEHP DNOP BBP DPP DIPP DHP
DEHP DNOP BBP
DEP DMP DIDP DINP DBP DIBP
DEP DMP DIDP

ISP6
ISP5 F
E
Evereve Ultra sanitary napkins
Bella Regular Drai Wing’s

0 500 1000 1500 2000 0 500 1000 1500

DPP DIPP DHP DEHP DNOP BBP DPP DIPP DHP DEHP
DEP DMP DIDP DINP DBP DIBP DNOP BBP DEP DMP

Figure1 (A – F): Presence of phthalates in the 10 samples tested in the study

35
 TABLE 1: PHTHALATES DETECTED IN THE SAMPLES

Samples details Phthalates (PPb or μg/kg)

Sample Sample name DIBP DBP DINP DID DMP DEP BBP DNOP DEHP DHP DIPP DPP
Id P
ISP1 Whisper 2350 1690 ND ND ND 840 ND ND 330 170 120 210
Ultra clean
ISP2 Stayfree Dry 500 430 ND ND 30 460 1810 ND 2450 370 80 220
Max
ISP3 Sofy Anti- 370 450 4820 7960 ND 10230 540 ND 660 260 1080 380
bacterial
ISP4 Nine Dry 3680 850 ND 170 10 1020 400 2320 250 60 200 130
Comfort
ISP5 Bella Regular 1110 1640 10 40 10 380 180 160 640 370 360 80
Drai Wings
ISP6 Evereve 460 470 ND ND 10 340 370 ND 1180 340 ND 280
Ultra
sanitary
napkins
OSP1 PEE Safe 3530 41920 ND 690 ND 840 720 2690 1020 830 20 480
100% organic
cotton biode-
gradable
OSP2 AZAH 230 ND ND 6170 ND 300 70 ND 80 ND ND ND
Organic Pad
OSP3 Plush 100% 320 350 6060 19460 10 220 560 540 2900 410 ND 1280
Pure US
Cotton
OSP4 NUA Light 110 290 ND ND 10 ND 60 1450 310 250 320 640
Flow

5.1.2 CONCENTRATION OF PHTHALATES IN ORGANIC PADS

A total of four organic sanitary pads samples were tested to check the presence of phthalates.
Phthalates were found in all four samples and the concentration detected was in the range of
10–41920 µg/kg. Out of the 12 phthalates tested during this study, 10 phthalates (353 µg/kg DIBP,
41920 µg/kg DBP, 840 µg/kg DEP, 720 µg/kg BBP, 2690 µg/kg DNOP, 1020 µg/kg DEHP, 20 µg/kg
DIPP 830 µg/kg DHP, 690 µg/kg DIDP, and µg/kg 480 DPP were found in PEE Safe 100% organic
cotton biodegradable (OSP1). DBP found to be highest in the concentration of 41920 µg/kg in OSP1.
AZAH Organic Pad showed the presence of five phthalates (230 DIBP, 6170 DIDP, 300 DEP, 70 BBP,
and 80 DEHP). Among the four samples, the second highest concentration of any phthalate was
found in Plush 100% Pure US Cotton (OSP3), with 19460 µg/kg of DIDP. Plush 100% Pure US
Cotton (OSP3) showed presence of DIDP (19460 µg/kg) and DINP, DEHP, DPP, BBP, DNOP, DHP, DBP
and DIBP with concentration of 6060, 2900, 1280, 560, 540, 410, 350 and 320 µg/kg respectively.

36
NUA Light Flow (OSP4) showed presence of DNOP (1450 μg/kg), DPP, DIPP, DEHP, DBP, DHP, DIBP,
BBP and DMP with concentrations of 640, 320, 310, 290, 250, 110, 60 and 10 μg/kg respectively. DIDP,
detected in three of the four organic samples, can pass from mother to baby during pregnancy and
exposure to this type of phthalate may affect the development of the child.61 Exposure to DIBP, again
detected in three of the samples, induces changes in body weight, liver weight, reproductive effects
and developmental effects.62 High-molecular-weight phthalates such as DEHP and BBP, or their
monoesters, are the major allergens causing asthma, wheezing, hay fever, itchy rash and eczema
in adults and gestational exposure of DEHP, BBP and DBP are the causative agents of allergic
responses in infants and toddlers. This gestational exposure of phthalates indicates the epigenetic
changes induced by phthalates.63

FIGURE 1: PRESENCE OF PHTHALATES IN ORGANIC PADS

6000

5000

4000

3000

2000

1000

0
Pee Safe AZAH Plush 100% NUA Light

DIBP DBP DINP DIDP DMP DEP BBP DNOP DEHP DHP DIPP DPP

37
 5.2 Concentration of VOCs in both inorganic and
organic samples
Sanitary napkins samples were checked for presence of a total of 25 VOCs. The list of VOCs tested
for is as follows:-

• Acetone • Styrene • 1, 2, 3 Trichloropropane

• Dichloromethane • M-Xylene • P-XYLENE
• N-Hexane • Trichloroethylene • 1, 1, 2- trichloroethane
• Chloroform • Penta chloroethane • Trans- Di-1, 2-chloroethane
• Tetrahydrofuran • Cyclohexanone • Cis-dichloroethylene
• 1,2 dichloroethane • o-xylene • 1, 1, 1-Trichloroethane
• Benzene • Phenol • 1, 1, 1, 2- Tetrachloroethane
• Toluene • N, N-Dimethylacetamide
• Cyclohexane • Carbon tetrachlorid

VOCs were detected in all the samples, inorganic and organic. Among these, acetone,
dichloromethane, N-Hexane, chloroform, Tetrahydrofuran, Benzene, Toulene, Cyclohexane,
M-Xylene, Cyclohexanone, o-xylene and 1, 1, 2-trichloroethane were detected in all the samples.
Trans- Di-1, 2-chloroethane, Cis-dichloroethylene and 1, 1, 1-Trichloroethane were not found in any of
the samples. The highest concentration among all the VOCs was of acetone, at 690 μg/kg in Bella
Regular Drai Wings (ISP5), an inorganic pad. But PEE Safe 100% organic cotton biodegradable pad
also contained a high concentration of acetone (591 μg/kg). It was shocking to find high levels of
VOCs in all the organic samples, thus breaking the understanding that the organic pads are safer.
Acetone, cyclohexane and cyclohexanone were found in all of them.

5.2.1 VOCs IN INORGANIC PADS

A total of six inorganic sanitary pads samples were tested to check for the presence of VOCs. VOCs
were detected in all the samples, ranging from 1-690 μg/kg. Acetone and cyclohexanone were
detected in high concentrations in all the inorganic pads tested during the study. Bella Regular
Drai Wings (ISP5) was found to contain 18 VOCs; namely acetone, dichloromethane, N-hexane,
chloroform, tetrahydrofuran, benzene, toluene, syclohexane, styrene, M-xylene, trichloroethylene,
Penta chloroethane, cyclohexanone, o-xylene, phenol, carbon tetrachloride, 1, 1, 2- trichloroethane
and N, N-Dimethylacetamide, 1,1,1,2-tetrachloroethane. Evereve Ultra sanitary napkin (ISP6) showed
the presence of 18 VOCs and with highest concentration of cyclohexanone at 291 μg/kg; followed
by acetone, phenol, N-Hexane, dichloromethane, toluene, o-xylene, tetrahydrofuran, chloroform,

38
carbon tetrachloride and benzene. Eighteen VOCs were detected in Sofy Anti-bacterial (ISP3)
with the highest concentration of cyclohexanone at 231 μg/kg and dichloromethane (95 μg/kg); and
varying levels of VOCs such as cyclohexane, acetone, toluene, n-hexane, o-xylene, chloroform,
tetrahydrofuran, styrene and penta chloroethane in different concentrations. Whisper Ultra clean
(ISP1), a very popular product, contained 14 of the tested VOCs, with acetone as the dominant one
with a concentration of 200 μg/kg. Stayfree Dry Max (ISP2), another popular product, also tested
positive for 14 VOCs, with high acetone (312 μg/kg) and cyclohexane (159 μg/kg) concentrations.
Nine Dry Comfort (ISP4) had 17 VOCs, with cyclohexanone (127 μg/kg) as the dominant chemical.

5.2.2 VOCs IN ORGANIC PADS

As mentioned above, all organic pads were also found to have VOCs. PEE Safe 100% organic
cotton biodegradable (OSP1) was found to have 17 of the tested chemicals, with high concentrations
of acetone (591 μg/kg) and cyclohexanone (66 μg/kg). AZAH Organic Pad (OSP2) showed high
concentrations of cyclohexane (254 μg/kg) and cyclohexanone (222 μg/kg).

Plush 100% Pure US Cotton (OSP3) showed the presence of 16 VOCs, with a high concentration
of acetone (225 μg/kg). PEE Safe 100% organic cotton biodegradable (OSP1) had 17 VOCs. Acetone
was found to be at 591 μg/kg, highest among the VOCs detected. It also tested positive for
dichloromethane, H-hexane, o-xylene, cyclohexane, M-xylene, 1, 2, 3 trichloropropane, toluene,
chloroform, tetrahydrofuran, benzene, toluene, penta chloroethane, N, N dimethylacetamide,
carbon tetrachloride, P-xylene, 1,1, 2-trichloroethane, 1,1,1 and 2-tetrachloroethane. NUA Light
Flow (OSP4) showed the presence of cyclohexanone (127 μg/kg), acetone (53 μg/kg), o-xylene,
cyclohexane, M-xylene, N-hexane, tetrahydrofuran and dichloromethane.

39
 ISP1

1, 1, 2- trichloroethane
P-XYLENE
Carbon tetrachloride
o-xylene
Cyclohexanone
Penta chloroethane
M-Xylene
Cyclohexane
Toluene
Tetrahydrofuran
Chloroform
N- Hexane
Dichloromethane
Acetone

0 10 20 30 40 50 60 70 80
A

ISP2

1, 1, 1, 2- Tetrachloroethane
1, 1, 2- trichloroethane
1, 2, 3 Trichloro Propan
o-xylene
Cyclohexanone
M-Xylene
Cyclohexane
Toluene
Benzene
Tetrahydrofuran
Chloroform
N- Hexane
Dichloromethane
Acetone

0 10 20 30 40 50 60 70 80

B
ISP3

1, 1, 1, 2- Tetrachloroethane
1, 1, 2- trichloroethane
P-XYLENE
1, 2, 3 Trichloro Propan
Carbon tetrachloride
o-xylene
Cyclohexanone
Penta chloroethane
M-Xylene
Styrene
Cyclohexane
Toluene
Benzene
Tetrahydrofuran
Chloroform
N- Hexane
Dichloromethane
Acetone

0 10 20 30 40 50 60 70 80

40
 ISP4
1, 1, 1, 2- Tetrachloroethane
1, 1, 2- trichloroethane
P-XYLENE
1, 2, 3 Trichloro Propan
Carbon tetrachloride
o-xylene
Cyclohexanone
Penta chloroethane
M-Xylene
Cyclohexane
Toluene
Benzene
Tetrahydrofuran
Chloroform
N- Hexane
Dichloromethane
Acetone

0 10 20 30 40 50 60 70 80

D
ISP5

1, 1, 2- trichloroethane
1, 2, 3 Trichloro Propan
Carbon tetrachloride
o-xylene
Cyclohexanone
Penta chloroethane
Trichloroethylene
M-Xylene
Cyclohexane
Toluene
Benzene
Tetrahydrofuran
Chloroform
N- Hexane
Dichloromethane
Acetone

0 10 20 30 40 50 60 70 80
E
ISP6
1, 1, 1, 2- Tetrachloroethane
1, 1, 2- trichloroethane
Carbon tetrachloride
Phenol
o-xylene
Cyclohexanone
Penta chloroethane
M-Xylene
Styrene
Cyclohexane
Toluene
Benzene
Tetrahydrofuran
Chloroform
N- Hexane
Dichloromethane
Acetone

0 10 20 30 40 50 60 70 80
F
41
 TABLE 5: CONCENTRATION OF VOCs IN SANITARY PAD

Compounds Sample IDs

Units (PPb) ISP1 ISP2 ISP3 ISP4 ISP5 ISP6 OSP1 OSP2 OSP3 OSP4
Acetone 200 312 67 63 690 57 591 37 225 51
Dichloromethane 65 25 95 1 1 17 2 20 18 2
N- Hexane 19 18 27 7 33 18 11 16 37 9
Chloroform 7 4 9 3 11 4 3 8 5 3
Tetrahydrofuran 6 3 7 2 2 10 7 2 4 3
1,2 dichloroethane ND ND ND ND ND ND ND ND ND ND
Benzene 1 1 1 1 1 1 1 1 1 1
Toluene 10 9 64 4 4 12 7 9 14 6
Cyclohexane 37 159 69 29 21 78 22 254 56 211
Styrene NA NA 2 NA NA 1 NA 1 NA NA
M-Xylene 28 13 46 25 12 12 7 26 19 32
Trichloroethylene NA NA NA NA NA NA NA NA NA NA
Penta chloroethane 2 ND 1 2 2 2 1 54 5 3
Cyclohexanone 60 27 231 127 63 291 60 222 91 457
o-xylene 22 10 21 50 4 11 6 19 59 49
Phenol ND ND ND ND ND 55 ND ND ND ND
N, N-Dimethylacetamide 4 3 7 4 11 3 6 7 29 4
Carbon tetrachloride 2 BDL 1 2 2 2 1 54 5 3
1, 2, 3 Trichloropropane ND 1 2 7 1 NA 1 1 ND 1
P-XYLENE 1 BDL 3 1 BDL BDL 1 1 1 BDL
1, 1, 2- trichloroethane 1 1 2 1 1 1 1 1 2 2
Trans-Di-1, BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL
2-chloroethane
Cis- dichloroethylene BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL
1, 1, 1-Trichloroethane BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL
1, 1, 1, 2- BDL 4 1 1 BDL 2 BDL 1 1 1
Tetrachloroethane

42
TABLE 6: CONCENTRATION OF VOCs IN SANITARY PADS (ON PER PAD BASIS).

S. No Name Maximum concentration Maximum concentration

(µg/kg) (µg/pad)
1 Acetone 690 6.9
2 Dichloromethane 95 0.95
3 N-hexane 37 0.37
4 Chloroform 11 0.11
5 Tetrahydrofuran 10 0.1
6 1, 2 Dichloroethane NA -
7 Benzene 1 0.01
8 Toulene 64 0.64
9 Cyclohexane 254 2.54
10 Styrene 2 0.02
11 M-xylene 46 0.46
12 Trichloroethylene 7-8 -
13 Penta chloroethane 54 0.54
14 Cyclohexanone 291 2.91
15 O-xylene 59 0.59
16 N, N-Dimethylacetamide 29 0.29
17 Carbon tetrachloride 54 0.54
18 1, 2, 3 Trichloropropane 7 0.07
19 1, 1, 2- Trichloroethane 2 0.02
20 Trans-Di-1, 2-chloroethane BDL
21 N, N-Dimethylacetamide BDL
22 Cis- dichloroethylene BDL
23 1, 1, 1-Trichloroethane BDL
24 1, 1, 1, 2- Tetrachloroethane 4 0.04

Average weight of sanitary pads is 10 gm.

43
 Key Findings
Phthalates and VOCs found in all
samples, including organic and inorganic
samples.

DIBP, DBP, DEP, BBP, DEHP, DPP and DHP

most commonly detected phthalates.

The highest concentration of phthalates

detected in the sanitary pads was 41920
µg/kg of DBP in OSP1 and second highest
was 19460 µg/kg of DIDP in OSP3, both
were organic pads.

The highest concentration among all the

VOCs detected was for acetone at 690
μg/kg in Bella Regular Drai Wing s (ISP5),
an inorganic pad.

44
45
46
Conclusion and
Recommendations
Menstruation or Periods is a monthly, natural occurrence for the vast menstruating population across
the globe, including girls, women, transgender men and non-binary persons of reproductive age. But
menstrual health has been often an ignored issue, mainly because it is considered, in most cultures,
a taboo subject- something which is to be discussed in whispers and wrapped in secrecy to avoid
attention.

In the last decade or so though, menstrual health is beginning to be recognized as not just a health
issue but also as a human rights issue in the global agenda. Though menstrual health is not explicitly
mentioned in the Sustainable Development Goals targets, it does have clear linkages to health,
education and gender equality issues. There have been several reports of menstruators facing social
exclusion and these stigma related barriers impacting access to opportunities including their rights
to education, work, sanitation, freedom and gender equality – and most importantly to good health.
This recognition has led to governments trying to improve access to menstrual products by providing
or subsidizing menstrual products for those who cannot afford them.

Government schemes on menstrual health in India primary focus

AS A MUCOUS
on educating menstruators and improving access to menstrual
products and in most cases include free distribution of sanitary
MEMBRANE, THE
pads, mainly disposable, commercial ones. In absence of proper
VAGINA IS CAPABLE
standards, these schemes usually pick up the low cost or easily
OF SECRETING AND
available products in the market. Studies have indicated that ABSORBING FLUIDS
menstruators, especially young girls benefit tremendously from AT A HIGHER RATE
these schemes. But what is often missed is the impact these pads THAN SKIN.
on health of users.

This study found that all sanitary pads surveyed (inorganic as well as organic) contained both VOCs
and phthalates. The amounts measured were different among the brands. As stated in the earlier
sections, Phthalates, have been linked to a variety of health concerns including endocrine disruption,
impacts to the heart and reproductive systems, diabetes, some cancers, and birth defects. Exposure
to VOCs increases the risk of brain impairment, asthma, disabilities, certain cancers, and the proper
functioning of the reproductive system. Considering the fact that women are exposed to a cocktail
of chemicals through various pathways, the study findings indicate the risks of additional chemical
exposure through sanitary pads. This is crucial to look into, especially as there are very limited data
or information available to demonstrate the effect of cumulative chemical exposure to health. In case
of exposure through sanitary pads, it is also of critical concern because of the exposure route site,
i.e. vaginal area, and the long-term exposure period. The pads come in contact with some of the
most sensitive and absorbent tissue in our bodies.

In absence of adequate standards and lack of proper labeling requirements mean that users have
no way of making informed choices. Being a consumer product, sanitary pads are regulated under
a BIS standard but these do not require any evidence of safety of raw materials. These standards

47
 are old and hence need to be looked into, as products have changed over time, with many additives
included now to attract consumers. Detection of these harmful chemicals in both inorganic as well as
organic products also clearly points that an ‘organic label’ is not enough. The use of chemicals is of
particular concern as current regulatory checks are not sufficient to ensure the safety profile of these
ingredients and enforcement is not robust.

Menstrual health and hygiene are of utmost important, but menstruators expect safe products; the
current study raises questions on that aspect. Though the study had limitations, mainly in terms of
the number and types of products included in the study, most of the popular and accessible sanitary
pads were included. Presence of phthalates and VOCs in the pads indicate the exposure risks
menstruators might be having. More research and testing are clearly needed to better characterize
and understand the potential health impact by the exposure, especially long-term and cumulative
exposure. The study finding raises a concern for the safety of using some of the products and
stresses on the need for efforts to reduce VOC and phthalate contents in these products.

Recommendations
People who choose to use menstrual products available in the market deserve to have access to
safe products and have the right to know what ingredients they are being exposed to.

A thorough investigation on the presence and potential impact of the exposure to VOCs and
phthalates to the menstruators through use of sanitary products and other female hygiene
products needs to be taken up.
Government and standards making bodies should be framing Standards for chemicals
(phthalates and VOCs) in sanitary products.
It should be mandatory for Producers to disclose the list of product ingredients. Mandatory
labeling to disclose ingredients should be brought in to ensure chemical disclosure.
Responsible advertising will ensure that Producers provide relevant information and adequate
warnings on the product.
Research and use of safer chemicals which could substitute these harmful chemicals in
menstrual products is required.
There should be regulations and schemes to promote substitution or reduction in the use of
harmful chemicals like phthalates and VOCs.

48
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