Adapting to local needs and preferences

Furthermore, new kinds of business models with sustainability orientations are continuously arising. One idea is a holistic concept that includes the whole menstrual cycle throughout a person’s entire life. Daniella Peri compares her concept to an online medical service but for menstrual cycle needs where lay knowledge including household remedies and indigenous practices is incorporated so as to pay respect to old traditional expertise developed over centuries as well as a reaction to the neglect of women’s needs and issues in Western medicine. She described it as,

“From menarche to post-menopause, with an offer including products such as thrush medicine, natural vitamins, smaller pads for those who bleed less or who are smaller people, pregnancy pads, UTI-tests, herpes medication, access to OBGYNs as well as a platform for “tailoring one’s wellbeing.”

To summarize, in order to innovate products that are of the greatest benefit to consumers, it is important to involve users in the development process. This might seem like an obvious point, but there are still many menstruators around the world that belong to segments that are under-served by the current menstrual product supply. Furthermore, there are certain potential tensions involved in listening to consumer needs, such as when consumers express a want or ‘need’ for products that reinforce the stigma rather than destigmatize, such as in the case with black panty liners. The stronger the stigma, the more such tensions are likely to arise when working toward destigmatization, but companies seem to be dealing with them by focusing on destigmatizing communication about products to affect public opinion in the long run.

times, economic, logistic and infrastructural aspects that affect user patterns need to be considered. Sofia Ekstedt at Essity stated that,

“We often say, a bit sloppily, that we are global, but we do not exist in the whole world. Instead, we are in South and Central America, the Nordics, Russia, around the Mediterranean, China, and South Africa. But this means you have to have different research questions, of course, depending on where you’re active.”

In other words, innovators must understand the local ways that the stigma on menstruation and menstrual products might affect users and their needs. It is not only the stigma that guides behaviors, however. Naturally, infrastructural and economic factors play in as well. For example, consumers’ income and access to toilets with doors and locks as well as to running water will affect how often they can change or empty products in a safe and hygienic way.

Developers at Essity have established a model for how consumer needs can be determined. This model can be likened with a hierarchy of safety, comfort, and discretion. These three concepts are fundamental for most consumers’ menstrual product needs around the world, the difference being how they are prioritized.

Sofia Ekstedt at Essity stated that,

“Consumer need can be seen as a hierarchy of safety, comfort and discretion, which is pretty similar for everyone, but people prioritize a bit differently. There are slightly different underlying needs depending on where you are. In Malaysia, for example, they want washable products, which maybe we don’t. So, there are various underlying needs.”

It is noteworthy that Essity do not actually sell their products on the Malaysian market, perhaps for the very reason that they have identified a preference among Malaysian consumers for reusable products, which Essity do not offer. This is similar to Johnson & Johnson who produce O.b. tampons sold off their femcare business in North America. This could, at least partially, have to do with the lack of demand for digital tampons, i.e., tampons that you insert with your finger, on the North American market. Instead, consumers in North America prefer applicator tampons, such as Tampax. Michael Moscherosch at Johnson &

Johnson stated that,

“We currently are not active in that business in North America, we sold that business to somebody else. But we are still very active in the rest of the world. So O.b. still belongs to Johnson & Johnson, and the big market for O.b. is Europe anyway. North America tends to be more interested in applicator tampons and that’s like Tampax or something like that. Why is that? I would say it’s a cultural thing.”

Tampax were considered too big, bulky and visible when carried to and from the bathroom in comparison to the much smaller O.b., at least when they were first introduced on the Swedish market. Christina Lloyd argued that this is why Tampax never gained any real market shares here,

“[…] Tampax’s tampons with applicators, […] they did not gain traction because they were too big. So, they were too visible and that was embarrassing.”

This sparks an interest regarding which of the two camps is more destigmatized.

Is it the North Americans who do not find larger, more visible tampons embarrassing, or is it the Europeans who are not afraid to insert tampons with their fingers and get their hands dirty – I mean bloody? This is probably difficult to determine from my data, but what the matter could indicate is that Essity’s prioritization model could, in fact, have some truth to it. It may well be that the comfort of using an applicator to swiftly insert the tampon and staying out of touch with one’s blood is a greater priority for North Americans than for Europeans. Exposing the fact that one is menstruating may be less of a concern, alternatively those using tampons will bring their handbag to the toilet with them so as to hide the tampon inside. Europeans, however, may find it more important that products are discreet and can easily be carried in one’s hand without showing to other people, and do not worry as much about getting more intimate with their bodies and menstrual blood in private.

Furthermore, because most products on the menstrual product market are developed for the middle- and high-income countries, there are few products that address the needs of those in the developing world. This implies that oftentimes the same products are used, but in suboptimal ways. This leads to consumers in developing countries being exposed to higher risks of product failure than those using the same products in developed countries, due to their different lifestyles and thus menstrual product usage patterns. Greater risk of product failure, or leakage, contributes to users being less comfortable about their menstruation,

which further reinforces the stigma rather than destigmatizing menstruation and menstrual products. Hence, in order to destigmatize menstruation and menstrual products, it is likely that developing products that are more adapted to local needs, including contextual aspects such as demographics, weather, and user patterns will contribute to a greater sense of comfort associated with menstruating. When comfort associated with menstruation is increased, this further likely implies that users gain confidence about menstruating, which in turn decreases the stigma.

Michael Moscherosch stated that,

“In the developed world, generally, the average wearing time is 4-8 hours, and this has been the case for a very long time so, generally speaking and if you look at adverse effects, you know that it’s a safe, assuming the product is hygienic and made according to the standards, it’s a safe time. It’s true that microorganisms grow in the napkin and the longer you wear it, the higher you get the bio burden but as I said, the interphase between vagina and napkin is somewhat limited through the natural seal that the labia minora forms so that the microorganisms on the napkin causing a vaginal infection is somewhat limited. It’s not impossible, but it’s somewhat limited.”

Thus, products that are sold on the markets in developing countries should, theoretically, be of higher quality than those in developed countries, due to the increased risk of infection, and be sold at a lower price. Because this does not seem like a very attractive business model, however, to my knowledge, no company to date offers such products. Hence, there seems to be some room for innovation in this area. Moscherosch explained that,

“What I think, the wearing time is a really, really important question, because, generally, what we find is that the average wearing time in low- and middle-income countries [LMICs] is much longer, as I said, driven by the lack of safe and sanitary locations to change, but also driven by the cost of the product. So, what we as manufacturers, and it doesn’t matter if you are a large-scale manufacturer or if you’re a small scale, rural manufacturer, what we have to be aware of is that we actually need to make products for LMICs that should have a higher performance standard than typical western products because of that long wearing time.”

The asymmetry between intended use by mainstream products on the market and how they are used in developing countries could further be one of the reasons for consumers’ negative experiences with them in reference to the previously

discussed social movement campaign #MyAlwaysExperience, which was started in Kenya. Hence, companies that develop products that are not being used as intended in specific places, might need to pay increased attention to consumers’

needs, especially if they do not belong to the primary segment for which products are developed, since the risk exposing consumers to ill-being and themselves to public criticism. Michael Moscherosch’s reasoned that,

“I have no idea if Procter and gamble sells different products in Africa and in Sweden. Assuming that they are selling the same product, and the consumers are not happy with the performance you have to start asking yourself ‘why are they not happy with the performance?’ and one of the reasons could be because the wearing time in Nairobi is longer than the wearing time in Stockholm.”

The notion that consumers in different places around the world use their menstrual products for a varying number of hours is something that Essity has picked up on. Instead of releasing different products on different markets, which they do to some extent, they try to maintain the same product line in all their markets to stay as cost efficient as possible. Nonetheless, they ensure that there are products within that line that cater to all markets. The most popular product in Europe may be one of the least popular in Mexico and vice versa. Sofia Ekstedt at Essity stated that,

“If you look at for example Mexico, you often talk about them using their products during a longer time, which is true for some extent. That means that we sell our largest product in Mexico – it’s a thick night product, that’s our bestseller – you should be able to use it for a long time. It’s not only used at night, but it’s also used during the day, because maybe you want to put it on when you leave your house in the daytime. So, it should hold until you come back, depending on what you’re doing. In Europe, our most commonly bought product is the thin, slightly shorter pad. So, it’s different but there’s a similar product in Mexico. However, it has much fewer users than in Europe. What we see is that those who use the large product in Europe and those who use the large product in Mexico – there, it doesn’t vary much in time, but it varies when you choose a different product.”

Furthermore, there is often a discussion about fragranced menstrual products. In the context of the developed world, including Sweden, the discourse surrounding fragranced menstrual products consists of two main arguments. Firstly, the products are seen as entirely pointless and reinforcing the stigma, through yet

another way women are told by society that they should be clean and fresh in ways that are not necessarily connected to what is natural, in accordance with, for instance, Essity’s description of the menstrual and vulva stigmas.

Secondly, fragranced menstrual products are discussed in terms of whether they should be permitted, as considered previously in terms of the Swedish Chemicals Agency’s view on the matter. The argument here is that there are many documented cases of allergic reactions to the fragranced products. In the context of the developing world, however, menstrual odor is a real issue for women who wear their pads for a longer time than recommended and would risk stigmatization if they were to start smelling. In other words, in places where menstrual products are used as intended, fragranced products are seen as reinforcing the stigma. On the other hand, the same products are seen as destigmatizing in places where concealing the menstrual odor becomes imperative to avoid stigmatization due to longer wearing times.

One could argue that products that are seen as reinforcing a stigma in one market should be removed from that market, while continuing to cater to those for whom they contribute to destigmatization. On the other hand, according to my respondents, there are users in all markets that wear products for a longer amount of time, and thus might have a need for fragranced products in order to avoid stigmatization. Further, it could be argued that dislike toward fragranced menstrual products is a display of ignorance toward those who lack access and financial means to change menstrual products as often as recommended. Michael Moscherosch stated that,

“The issue with fragrances is that you don’t need fragrances for the napkin to perform, but consumers very often want it because they want to address the potential risk of menstrual odors. That’s specifically important in low- and middle-income countries where the wearing time of the products tends to be much longer.

I mean the issue there very often is that women don’t have the facilities to change their products, so they put the product on in the morning and wear it all day long and then change it again at night. Which is, you know, twelve hours or even longer than that. So, the longer the product is worn, the more potential there is for menstrual odor and consumers try to address that by using scented pads.”

Another aspect that guides menstrual product preferences and, hence, innovation and product development is tradition. Girls tend to use whatever their mothers

use and thus can be found at home. Traditions can cause certain cultural preferences to develop more slowly, such as the demand for thicker products.

Developers argue that thicker products do not necessarily absorb more, but certain consumer segments seem to feel a greater security in the palpable thickness rather than in the less tangible high-absorbency thinner materials. This could be connected to the notion that before they were developed into thinner, more technologically advanced products, pads were indeed thicker. Perhaps, there has been a tradition of using products that are thicker, which has not moved as quickly as in other parts of the world. Whether this is the case or not, thicker products are preferred, for instance, in Mexico, as discussed, but also in certain segments in Russia among other places. Sofia Ekstedt at Essity stated that,

“Sometimes, we launch products only for Russia, for example. It can be a product in a lower price segment because maybe a consumer segment can’t afford all the extra features – there might be a need for a slightly cheaper product. Or, for instance, these thicker products, because in some countries a thick product means it’s a good product because in their conceptual world, it means that it is safe and secure. Not necessarily because it absorbs more, but for them, that’s what it signals.

So, then we sometimes give them that.”

To summarize, local adaptation of innovation and entrepreneurship efforts need to be taken into consideration in order to further destigmatization since different users have different needs. Also, if those needs are only met in a selected number of places around the world, that is likely to further stigmatize those whose needs are not met adequately, which contributes to increased inequality and stigmatization for other associated reasons. Because they (we) are such a large group, menstruators vary infinitely, not only in user patterns and physically, but also with regard to aspects such as ability to pay, access to infrastructural resources such as private bathrooms with locked doors and running water, and not least, weather conditions. One size does not fit all. Thus, in order to increase consumers’

comfort and confidence associated with menstruation and menstrual products in general, products need to cater to those needs in order to contribute to destigmatization.

Furthermore, increasing consumer driven innovation and entrepreneurship, that address consumers’ real needs and demands is likely to contribute to an increased variety of products on the market. With more products on the market, it is likely that consumers find products that meet their particular needs. This will likely

make them more comfortable and confident about their menstruation, which further contributes to destigmatization.

Traditionally, however, large companies produce similar products for a wide, often global, or at least semi-global, market. This seems to be changing, however, where initiatives do pertain to different market segments, whether it be high- or low-income segments or those environmentally conscious. This is may lead to further market segmentation, which can increase consumers’ ability to choose products that suit them better. With such a large portion of the population that is in need of menstrual products, comes many different body types, bleeding patterns, and financial circumstances. These aspects could be seen as drivers toward segmentation of a lucrative market of a recurring need. The more attention companies and society in general pays to individual menstruators’ needs, the more empowered they are likely to become and the greater confidence they are likely to gain. These aspects in turn contribute to destigmatization.

6.3. Framing on the institutional level: Feminism and