Every month, more than 8 million people in Canada reach for disposable tampons and pads that end up in landfills. Three ƽ岻 medical students argue that education about greener period products — favourable for menstrual and environmental health — starts in clinics and the doctor’s office.
Third-year medical students Jiayin Huang, Shiyang (Alice) Shen, BSc’15, BSc’18, and Owen Dan Luo (MDCM’23, pictured above, left to right) wrote the article out of concern for the medical profession’s environmental footprint, and after seeing for themselves during clinical placements how the climate crisis and extreme weather events, such as heat waves, are making patients sicker.
“It got me reflecting on the climate crisis,” said Luo about his placement in family medicine. where doctors were treating patients with symptoms of heat-related illnesses, “and what we can do as healthcare professionals and future doctors to mitigate and adapt to the crisis.”
Their piece, published by BMJ Opinion this summer, draws attention to the ecological consequences of health workers' overreliance on single-use plastics worsened by the COVID-19 pandemic. Today, the blue face masks lining sidewalks are emblematic of the pandemic’s waste problem. But before COVID-19 — and long after this pandemic is declared over — plastics from single-use menstrual products have been finding their way into trash and water systems.
“We wanted to focus on the sheer amount of plastic contributed by these single-use products that accumulate over one’s lifetime,” and which takes many decades to break down, said Shen. “These are permanent damages... it’s important to think about, in terms of the scale of waste that we’re producing.”
Pads and tampons used to be made with fabrics, cotton and cardboard. The proliferation of plastics found new purpose in applicators, wings and strings. While these synthetic materials improved the absorbency of pads and tampons, they increase the environmental impact of menstrual products, on top of the fact that these products are individually wrapped in plastic. “Any kind of fabrication or industrial process to produce a product, especially a plastic one, is certainly going to have a carbon footprint,” said Luo.
In landfills, plastics can disrupt ecosystems through runoff water. “Natural systems have a major role to play in carbon reduction,” he added. “We don’t talk enough about wetlands, algae, or other forms of microorganisms that are present in those natural systems and are also carbon sinks. If you imagine that more toxic or noxious chemicals and plastic waste are going from landfills into those natural systems, they can be in disequilibrium.”
And though menstrual product innovations were convenient, especially as more women entered the workforce, they also fostered a dependence on disposable products that can be difficult for some to afford. In 2019, a survey by charity Plan International Canada found one-third of women and girls in the country had sacrificed something in their budget in order to purchase period products. Reusable products such as menstrual cups and period underwear have greater sticker prices but can last up to a decade. The initial $35 for a menstrual cup made of medical-grade silicone is a fraction of the estimated $70 a year spent on tampons and pads.
The financial and environmental benefits of reusable period products are advertised by manufacturers, but Huang, Shen and Luo’s article calls on healthcare workers to educate their menstruating patients. “Patients have trust in healthcare professionals,” said Huang. “It’s a precious resource to have doctors counsel on this and provide the health, environmental and financial co-benefits of reusable menstrual products. Not just talking about it on social media or in the pharmacy aisles.”
Physicians have a role as health educators, says Shen, and patients are likely to seriously consider their doctors' advice. “Especially since menstrual products are choices that are relatively simple to transition into, as opposed to other lifestyle choices,” she added.
In their first years of medical school, the co-authors have shown leadership as advocates for sustainability. Luo is co-chair of the Canadian Federation of Medical Students’ Health and Environment Adaptive Response Task force (HEART). One of HEART’s initiatives, founded by Luo, is Project Green Healthcare/Projet Vert la Santé, which funds projects that make the Canadian health system greener.
Huang and Shen participated in Project Green Healthcare/Projet Vert la Santé by creating a website, , with educational resources for students and healthcare providers about sustainable practices. “We’re trying to gather information from different hospitals (about their green initiatives) so when interested students start their rotations they can know where to look,” said Huang about Inspire Sustainability.
Together the three students won a virtual case challenge hosted by the Emerging Leaders in Environmental Sustainability in Healthcare (ELESH), an organization led by University of Toronto health scholars and professionals. Their winning proposal called for the reduction of single-use menstrual products in Montreal, which led to the article published by BMJ Opinion.
Echoing her peers, Huang said she was always interested in advocating for green habits, “but when I started med school a lot of us realized that the climate crisis we all are worried about, we are also contributing to.”
Luo says he was disenchanted after witnessing bad habits in hospitals, such as excess glove use when doctors snap on a new pair before typing notes or making a call, and recyclable items in operating rooms being tossed in the biohazard bin. “It’s a polluting service,” says Luo.
“We talk about ‘do no harm,’ and I think we do a great job towards patients, but right now the healthcare system as a whole is doing harm to the planet,” he said, citing a study that found that the healthcare system accounts for 4.6 per cent of Canada’s carbon emissions, ultimately harming the health of the population.
“People who are harmed (the most) are marginalized communities,” Shen said. “We talk about health equity and policy, but the environmental crisis plays a role.”
According to the three co-authors, reusable menstrual products also deserve to be mentioned in the reproductive health block of the medical curriculum, along with the medical profession’s responsibility towards climate change adaptation and mitigation. Now is the time to change menstrual habits and counselling, they say, because the COVID-19 pandemic is forcing every element of society to adapt one way or another.