Inner Sanctum

The Hidden Price of Feminine Hygiene Products

The feminine hygiene industry has made revolutionary innovations since the original maxi-pad—which was nearly three feet long. And no doubt we have come a long way from surreptitiously paying for purchases in a box on the counter of drug stores. Discussion of the products’ impact, however, is still very much under wraps.

Deceptively Pure

GAP-white jeans in full-page ads and televised commercials of confident strolls down the beach don’t tell the whole story. In fact, the sterile whiteness of the products themselves can be deceptively reassuring. Although the original cost of chlorine bleaching—the release of some 250 different organochlorines and a product laden with dioxin—was traded in during the mid-1990s for “elemental chlorine-free bleaching,” is it really now risk-free?

Even the Food and Drug Administration (FDA) acknowledges that chlorine dioxide, though elementally chlorine free, can still “theoretically generate dioxins at extremely low levels,” and, according to the Environmental Protection Agency (EPA), no safe level for dioxin exposure exists. The compound is 10 times more likely to cause cancer than was believed in 1994, says the agency, and even average background levels may lead to non-cancer health effects, including developmental delays, birth defects, hormone disruption and immune cell suppression. The toxin accumulates in humans, particularly women’s body fat and breast milk, with repeated exposures, and 16,800 tampons over the course of a lifetime certainly qualifies.

Nor is the environment off the hook. The Worldwatch Institute calls elemental chlorine free bleaching a “‘low-tar cigarette’ approach to the problem of organochlorine pollution,” reducing (not eliminating) pollution, but not addressing the fundamental problem—the continued use of chlorine. Hydrogen peroxide, oxygen or ozone work just as well, though any bleaching, the organization points out, still uses energy, water and materials unnecessarily.

Shock to the System

Another improvement that falls short came with the phase-out of all synthetic fibers but one from tampons, says Dr. Philip Tierno, director of microbiology and diagnostic immunology at New York University Medical Center. Independent studies he conducted revealed that synthetic fibers, incorporated in the 1970s to increase absorbency, amplified toxins of the Staphylococcus aureus bacteria, which cause Toxic Shock Syndrome (TSS). By 1980, the potentially life-threatening bacterial illness had reached its peak, and carboxymethylcellulose, polyacrylate rayon and polyester were pulled from the market. The fourth fiber, viscous rayon, remains in use today.

“Viscous rayon does amplify toxins less than the others,” says Tierno. “But manufacturers are still saying nothing’s wrong with it, and that’s not the case. The lowest risk [for TSS] would be had by using all cotton.” The FDA, which regulates feminine hygiene products as medical devices, disagrees, maintaining that rayon tampons are as safe as cotton ones, and that the exact link between tampons and TSS remains unclear.

Such government reassurance is little comfort to many women’s health advocates: “FDA doesn’t do independent testing, it relies on testing by manufacturers,” says Amy Allina, program and policy director for the National Women’s Health Network. “People may legitimately raise questions about reliability.”

Get Out the Vote

Enter the proposed Tampon Safety & Research Act (H.R. 890), which would direct the National Institutes of Health to conduct research on the risks dioxin, synthetic fibers and other additives may pose for the 73 million U.S. women who regularly use tampons, and who may be at disproportionate risk for endometriosis, breast and reproductive cancers.

House representative Carolyn Maloney (D-NY) plans to introduce the bill for the third time in 2001, along with the Robin Danielson Act (H.R.889), which would direct the Centers for Disease Control and Prevention (CDC) to establish a program to collect data on TSS. (Although only three cases were reported in 1998, down from 813 in 1980, according to the CDC reporting has so far been optional and uneven.)

“We need to find out what the healthiest feminine hygiene product is,” says Susan Alderson, vice president of Organic Essentials. “And whatever that turns out to be, women will then have a choice.” Organic Essentials, by growing its own certified organic cotton through 27 farm families, ensures none of the 35 different chemicals typically applied to conventional cotton are introduced to its tampons, which are then whitened using hydrogen peroxide, a totally chlorine-free method.

Jay Gooch, a toxicologist with Procter & Gamble, insists the difference between elemental chlorine-free and totally chlorine-free bleaching is “not discernible,” however, and the difference between rayon and cotton fibers, both cellulose, “not consequential.” “The research we’ve done and others have done for us is rigorous and we stand behind it 100 percent,” says Gooch. Tampax Naturals, Procter & Gamble’s own all-cotton tampon, was pulled from the market after not proving a big seller.

Environmental Burden

To further complicate an extremely convoluted, personal and emotional subject, there is yet another aspect to feminine hygiene often overlooked. According to waste consultant Franklin Associates, 6.5 billion tampons and 13.5 billion sanitary pads, plus their packaging, ended up in landfills or sewer systems in 1998. And according to the Center for Marine Conservation, over 170,000 tampon applicators were collected along U.S. coastal areas between 1998 and 1999.

But it’s not just a landfill issue, says Brenda Mallory, founder of Glad Rags, which produces colored and organic cotton pads with washable liners. “People forget about the production end of disposable items,” she says. “Constant production creates pollution, too.”

Ironically, lack of exposure (no magazine would accept advertising) halted the introduction of the first disposable menstrual pad in the U.S. in 1896. Today, as sales of disposables surpass $1 billion (with $700 million more from sales of tampons), reusable menstrual pads face a like challenge, with the added hurdle of educating women on why reusables are even important. Not to mention that the very concept of reusables bars repeat consumers, at least for the five- to 10-year lifespan of the product.

“We will never be a box of tampons,” admits Mallory. “We don’t have that built-in obsolescence. It has limited how we can grow as company,” she says, “but you know what? That’s not what it’s all about.”

Knowledge is Power

As the FDA does not require companies to print ingredients or bleaching processes on the packaging of tampons or pads, here’s the information you won’t find on the box: According to company spokespeople, Johnson & Johnson (manufacturer of OB, Carefree and Stayfree) and Kimberly Clark (Kotex) use cotton/rayon blends in their p

roducts, Playtex uses only rayon and Proctor and Gamble (Tampax and Always) uses both cotton-rayon blends and rayon alone. All use elemental chlorine-free bleaching.

If those answers don’t satisfy you, here are a few more alternatives: Natracare carries all-cotton certified organic tampons and non-chlorine, hydrogen peroxide bleached pads (now with wings). Three more washable pads are Lunapads and Many Moons, each with prints and organic versions, and certified organic Pandora Pads. They each use only totally chlorine-free bleaching, and no bleach at all on organic items.

“Women should have a drawerful of options,” says Lou Crawford, founder of The Keeper, which makes natural gum rubber cups inserted to catch menstrual flow. One Keeper lasts up to 10 years, breaking down to an investment of 29 cents a month. Another softcup, Instead, is made of a polyethylene and synthetic plastic blend, and like the Keeper will not breed staph toxins and is approved by both Health Canada and the FDA. (However, it is disposable.) Jade and Pearl shapes natural sea sponges, yet another option, to fit a woman’s body, absorbing flow and likewise averting the dilemma of throwaways, synthetic fibers and bleaching.

“For hundreds of decisions that women make everyday, we are balancing health, safety, convenience and efficacy,” says Allina. “And we certainly don’t always choose the risk-free option.” But we should at least be aware of the risks.