3.2.1 Secrecy and respectability.

All participants described a profound secrecy around menstruation, as Chifundo [50s, suburb, UDDT, cloth] explained: ‘It’s because of our culture, it doesn’t allow that anyone should see [blood]’. It was important for all participants to hide any visual, olfactory, or behavioural signs of menstruation, and they would exert considerable effort and energy towards concealment. It was considered shameful for others to see signs of menstruation, as Elizabeth [late teens, suburb, pit latrine, pads] described: ‘When I use the toilet, maybe I have spilt some blood and I didn’t check and see it, and my dad enters the same toilet, he may feel disgusted… it doesn’t bring respect’. It was considered particularly essential to keep the signs of menstruation secret from men and young children; some participants even described it as ‘dangerous’ for them to see signs of menstrual blood. Others spoke about hygienic and moral imperatives to keep menstruation secret. Pilirani [20s, KI, flush, pads] described a conversation she had with her mother, who told her: ‘Menstrual blood is filthy. It is not like the regular human blood. It stinks, so for others to see it is not good at all’. Two participants mentioned that people may discreetly refuse to eat food that they had prepared if they were known to be menstruating: ‘Others when you cook food may say they are full, they don’t want the food, and see you as filthy’ [Dalitso, 20s, campus-student, flush, pads]. Most women said they would feel comfortable discussing menstrual health concerns with a doctor, due to their perceived confidentiality. Chifundo [50s, suburb, UDDT, cloth] said: ‘Menstruation is a private thing… so if you have any problems it’s better to go and see a doctor who cannot disclose it to anyone’. Some women commented that secrecy around menstruation was less severe than previously, with young women today feeling more freedom to share their menstrual problems with friends, and in trusted spaces like church groups.

3.2.2 Menstrual cloths as healing objects.

In apparent contrast to the taboos associated with menstrual blood described above, many women also believed that menstrual blood had healing properties, as Fatsani [30s, suburb, pit latrine, cloth] commented: ‘There is goodness in menstrual blood’. Small amounts of menstrual blood remaining in the menstrual cloth after washing (as evidenced by staining and discolouration of the material) was believed to give the cloth medicinal qualities; cloth which had never been used to absorb menses, or ordinary blood, were not thought to have the same effect. Chisomo [50s, campus-staff, cloth] explained ‘The thing making cloth to be powerful is the [menstrual] blood.’ Many participants, particularly those who were older, described using (or being aware of others using) cleaned menstrual cloth in traditional medicine practices. Kondwani [40s, suburb, pit latrine, cloth] explained the use and process: ‘If your child gets sick then you take the [clean] menstrual cloth and warm it on the fire then put it on the body of the baby and the baby gets well, or even when you are having flu or cough, you take the menstrual cloth and warm it on the fire, then inhaling it the cough or flu goes away.’ Limbani [50s, suburb, UDDT, cloth] added another example: ‘If your child has been burned by fire, we take [the menstrual cloth] and we use it on the wound, and the wound dries up so easy’. Several women kept their menstrual cloths in case they were required by an ill or injured family member, even after they were worn out and no longer functional in their original sense. One woman required permission from her husband before discarding menstrual cloths, as they were considered so valuable.

3.2.3 Fear of ufiti.

Almost every participant feared menstrual blood being used in ufiti (witchcraft). If another person got hold of a menstrual cloth or used pad, or even stained underwear, it was believed that they could take it to a sing’anga (witch doctor) and use it to cast ufiti over the owner of the object, causing them harm. As Mercy [30s, suburb, UDDT, cloth] explained, ‘It is dangerous for us women, taking the cloth with blood and disposing it… Someone sees it, maybe they can do some bad things to you’. Possible effects were said to include menstruating continuously for several months at a time, infertility, or (more rarely) death. Many women, old and young, claimed to know friends or family members who had personally experienced harm from ufiti through stolen menstrual absorbents, and it was perceived as a relatively common occurrence. Mayeso [30s, suburb, pit latrine, cloth] described the experience of her mother: ‘Other people can make you to be barren, like my mother, her cloth was stolen and she couldn’t conceive again.’ Some women also believed that menstrual cloth or used pads could be stolen and used in other kinds of ufiti to bring wealth or prosperity to the thief.

The secrecy around menstruation was therefore due not only to embarrassment, but also to fear. Women took great care to keep their menstrual cloths secure and hidden at home, so that they were not vulnerable to ufiti. Some spoke of taking pains to hide them from their own husbands. For those who used disposable pads, they took care to dispose of these ‘safely’ so that nobody else could get them. Elizabeth [late teens, suburb, pit latrine, pads] described how she protected her used pads from being used in ufiti’: ‘it’s just to be storing them safely like I do, I store them [in the bedroom] then burn them, in order to avoid such kinds of things’. Whilst burning and discarding in pit latrines were thought to be safe options, many women were wary of the idea of discarding their pads in the open, or leaving them in a bin. The higher volume of waste created as a result of using disposable pads was seen as a negative aspect by some women, who felt that cloth was safer and left them less at risk of ufiti.

Fears of ufiti was generally felt more acutely by the older women. Some (but not all) of the younger university-attending women were prepared to discard pads in the bathroom bins on campus, provided that the bathrooms were kept locked out of hours, which they felt provided adequate protection against ufiti. The older women confessed their fears for the safety of the younger women as a result of their more relaxed attitudes; Tadala [40s, campus-staff, cloth] gently admonished the young female interviewer: ‘You younger generation, you don’t take things seriously, you don’t even think that your own [pads] can affect you’. Some, however, felt that times had changed and the risks of ufiti had reduced; Takondwa [60s, suburb, cloth] commented: ‘During the olden days it was more dangerous [than now]’. Chimwemwe [30s, suburb, UDDT, pads] regretted seeing more discarded waste as a result of this attitudinal shift: ‘Pads, they are not well taken care of, they are just everywhere, because now people are not afraid of blood any more’. Mphatso [30s, campus-staff, cloth] reflected on the differences, and speculated that it might be due to education: ‘Our parents, when they teach us that, my child, take care of [the cloth] when menstruating, we were listening, maybe because of being uneducated. But now, today, when you tell them that cloths, don’t keep them anywhere… they see it as useless.’

3.2.4 Menstrual restrictions.

There were a number of restrictions associated with the state of menstruation. Acts mentioned by participants which should be refrained from during menstruation included: adding salt to food; having sexual intercourse; picking vegetables from the field; having physical contact with children; and cooking food. The most common abstinence discussed was adding salt to food; this was something that several participants were advised to do by their elders, although none were able to explain why. These women would typically ask another member of the family to add it instead. The salt restriction appeared to be viewed similarly to a religious affiliation, with some women choosing to adhere to it and others choosing not to. Tadala [40s, campus-staff, cloth] explained: ‘Others say [when menstruating] that you shouldn’t add salt to relish [a dish of vegetables and/or meat to accompany rice or nsima], but me, with the way I pray, I don’t see that there is any problem with it much.’ Some of those who refrained from adding salt added that whatever danger was once associated with it may no longer be present, but they still prefer to keep the practice anyway. Limbani [50s, suburb, UDDT, cloth] explained: ‘The way we were told, when menstruating, adding salt, people [who eat the food] get swollen. But now, it’s no longer there, we can add salt. But to us who got adapted [to not adding salt], we are still believing that.’

3.3.1 Reuse by washing.

In terms of day-to-day menstruation management for cloth-using women, the most important household facility was the bathroom. In many Malawian households, the bathroom is located in a separate building to the main dwelling, and is typically a small room with a drain leading into either: the pit latrine; the ground (i.e. an improvised soakaway); or an open channel, possibly connecting to a public ditch or discharging elsewhere in the compound. The bathroom is usually separate to the toilet room, but may be adjacent. All washing activities (of the body and the cloth) take place in the bathroom, and the privacy of the space is very important. Water draining from the bathroom should not be publically visible, so that bloodied water from washing the cloth cannot be seen by neighbours or passers-by. One cloth-using participant, Fatsani [30s, suburb, pit latrine, cloth], commented that covered drainage from her bathroom was the thing she desired most in her whole life.

3.3.2 Disposal by burning.

Disposing of pads and cloth by burning was preferred by many women but, owing to the secrecy around menstruation, this had to be carried out in a discreet location either early in the morning or in the evening when nobody else was around. Pilirani [20s, KI, flush, pads] explained: ‘Girls are supposed to… burn them in a secret place, if there are men in the house you’re supposed to wait for them to be out.’ Some women noted that it can take a long time for a pad or cloth burn completely, particularly if it is wet. In order to speed up the burning process, they would therefore sometimes leave pads to dry in the sunshine on toilet rooftops, but admitted that they worried about the pads being stolen and used for ufiti whilst left unattended. Others mentioned that burning pads causes a noticeable odour, and which caused them to feel uncomfortable as it could alert neighbours to their activity: ‘When you burn, it will produce air pollution, and people around the neighbouring houses will notice something [i.e. that you are menstruating]’ [Thoko, 20s, campus-student, flush, pads]. Despite these inconveniences, burning was generally regarded as a safe solution as it turned the pads and cloth to ash, protecting them from being used in ufiti, and preventing them from being seen by anybody. In one unusual case, a woman burned her pads directly inside her UDDT vault, by burying them in hot ash.

In order to conserve matches and paraffin, some women preferred to burn their used pads together, in one go, at the end of their period. However, storing used pads discreetly was challenging as they emitted a strong odour and attracted flies. Women worried about other people in the household smelling or finding the pungent pads, as well as experiencing personal discomfort from keeping them in their bedrooms. Pilirani [20s, KI, flush, pads] explained how she would ‘gather [the used pads] in a plastic bag under my bed, they produce some bad smells and so windows are to be open, but during the night, eeiish…’ Having to store odorous pads in a bedroom shared with young children or boys caused particular anxiety. Some, however, developed innovations: Margaret [late teens, suburb, UDDT, pads] stored her used pads in an airtight container (made from an old paint tub) in her bedroom, which effectively contained the odour, after hearing the idea from a friend at church.

3.3.3 Disposal in toilets.

Throwing pads and cloth in pit latrines was another common disposal route. This was regarded as a particularly useful ‘emergency’ option, as items could be dropped into a pit latrine quickly and discreetly. However, some pad-using women preferred not to routinely discard pads in their own pit latrines as they feared that it would cause the pit to rapidly fill up, shortening its useful lifespan, and would therefore only throw the occasional pad or cloth when unable to dispose of it by burning. If the pit latrine was designed for routine emptying, some women also had concerns about discarding pads in these toilets because of the potential for pads to physically cause problems with emptying devices (described by Elizabeth [late teens, suburb, pit latrine, pads] as ‘blocking the pipes’), and also due to embarrassment from others seeing the pads during the emptying process.

Those with flush toilets or UDDTs, unable to throw pads or rags in their own toilets, would sometimes secretively throw their items into their neighbour’s pit latrines. Tiyamike [20s, suburb, UDDT, pads & cloth], who had a UDDT, admitted: ‘Sometimes you fail to wash menstrual cloth, then you say I should dispose to the neighbour’s toilet [a pit latrine]… you are to wait for the neighbour to be out or not around, then you run and dispose them.’ However Tiyamike worried that this could cause conflict with her neighbours if her actions ever came to light.

3.3.4 Disposal in bins or dumps.

Discarding pads or cloth into the solid waste system, whether in bins or on local dumpsites, was generally seen as an unfavourable option and used as a last resort. This was partly due to the risk of pads or rags being taken (from either the bin, or the final destination) and used in ufiti, but also because it contravened the expectation that they should be kept hidden, and was therefore seen as immoral and disrespectful. This feeling was particularly strong among the older generation of participants, who felt dismayed to see bloodied pads scattered around like litter. Younger pad-using participants expressed particular anxiety about dogs scavenging their pads from bins and carrying them away, which may account for how pads end up dispersed in the urban environment despite the general wish to keep them hidden.

In spite of the general discomfort around discarding pads in bins (due to not knowing the ultimate destination of the waste, and whether this would be safe from ufiti), some campus students who had flush toilets at home and did not wish to burn their pads would nonetheless carry them to university each day and leave them in the bins there. Joyce [20s, campus-student, flush, pads], who has a flush toilet at home, explained: ‘I don’t feel comfortable burning them, so most of the times I do carry the ones that I’ve used, and throw them in the bin at the [campus] toilet.’ Cleaners at the campus confirmed that they regularly find bundles of used pads in plastic bags discarded in the bins.