Increasing transparency regarding product safety

A first step in ensuring that actors do understand the aims of the standardization can be to visit the most important actors and ensure, through personal contact, that they understand what the project entails and what is required of them if they are to participate. Helene Edmark at SIS stated that,

“Standardization works best if you visit the most important actors at their offices before you hold a stakeholder meeting. So, you know that you can start and then you can clarify the questions to address, test methods, limit values and what is interesting for them. So, you have the decision-makers with you from the start.

Then you have a starting-up meeting, instead of an information meeting, which is what you normally need to hold, and then we hopefully know that we can start because we have the most important actors on board.”

In the case of menstrual product standardization, we were never able to arrange such a meeting because Essity were not interested in doing so. Hence, on the one hand, Essity argued that they were uncertain about what the standardization would entail and were reluctant to participate for that reason. On the other hand, they were not interested in meeting to discuss what the standard indeed would entail or what it could entail and that they very much had the ability to be involved in determining what it would entail. I would argue that if there would have been an opportunity to discuss the aims of the standardization and create a mutual understanding thereof between Essity, SIS and myself, there might have been greater potential for the standardization process to go further.

extraordinarily imperative to report results as transparently as possible in this project, due to firstly the size of the user group and the risks implied by arousing undue suspicion on products. There was a lot of media attention paid to the project as it was announced by the government, which caused the agency to take greater precaution regarding the information they released in their report and how it was to be formulated so as to prevent excessively negative reactions from the public. Project leader for the investigation of chemicals in menstrual products at the Chemicals Agency, Amanda Rosen, stated that,

“Just because it is such a common product that everyone who menstruates uses, it also becomes extra delicate when you are to present the results. So, we have thought a lot about how to present the results and what words to use. For example, it is not always that we present data as transparently as possible, normally we don’t do that.

In this case, we thought it was probably best to go out with as much as possible at once because it will anyway be requested later on, rather than giving some information to one journalist and some to another. In this way, we had more control over how the study was presented. So, that was special…And we think that we can calm people down and that we have reason to say that there is no great risk [of using menstrual products] and that there are other things to focus on instead.”

On the one hand, the Chemicals Agency indicated that the risks involved in using menstrual products on the Swedish market, currently, are slim. On the other hand, they also pointed out the importance of increasing the knowledge about this product group including how they affect people and the environment. There is a risk that the results worry people to an unproportionate degree than they think reflects their risk judgement. If people think that the products they use are unsafe, there is a risk that products become further stigmatized than they already are.

Therefore, the Chemicals Agency sees it as important that they do not trigger alarmist reactions. On the other hand, by talking about the results as though there is nothing to worry about, they can also be considered to be downplaying the results, since there were, in fact, 21 chemicals that might be dangerous, of which they know very little. Anna-Lisa Persson at the Consumers’ Association agreed with this notion and stated that,

“So, it is important to remember, when talking about menstrual products that we do not rattle people up by saying that there are lots of dangerous chemicals in them, because they are not very dangerous. So, we do not want to scare people

from not using menstrual products and staying at home in bed when menstruating.

From a societal perspective, that’s not a very good idea.”

When the results of the report were published, there was much less attention from the media than when the project was initiated. This could signify that the notion that products could contain hazardous chemicals was much more worrying.

Another reason why it gained much attention initially was because of the gender equality perspective, where media discussed whether it was because of the products being directed toward women and girls that they had been neglected.

Once the Chemicals Agency investigated the matter and concluded as well as communicated to the public that there was no need to worry, the matter was again destigmatized, as people trusted in their expertise and knowledge. Rosen stated that,

“the report didn’t gain a lot of attention; you could say the attention was greater before we started working than what it was when we actually published the report.

But the initial attention related to it being a product that is primarily directed toward women and there was an equality motive about it being a product that women use, why hasn’t it been better examined? Whether that’s the reason why there hasn’t been more care to find out if there are any risks. And then, of course, because they are used so intimately with the body and on the inner mucous membranes, of course, the mere thought of them containing hazardous substances makes you worried.”

Furthermore, when the safety of menstrual products is discussed, it is often in terms of Toxic Shock Syndrome (TSS), a condition commonly referred to as ‘the tampon disease’ in Swedish. Health experts such as gynecologists maintain that when misusing menstrual products such as tampons, the lack of communication about the risks implied can put users in danger of losing a body part or even dying.

Gynecologist, Christina Lloyd emphasized that the stigma on menstrual products prohibits people from talking openly about them, as well as associated risks, which causes ignorance, further amplifying the risks. Lloyd stated that,

“Another aspect is that people might not understand the hygiene aspect fully, so that’s where menstrual products come in; if you do not know the foundations of hygiene, you’re exposed to a lot of risks, such as if you forget an inserted tampon.

There are syndromes such as TSS which is a large risk. So, if you do not want to

talk about something and there is a high level of ignorance, then risks are also higher.”

On the other hand, while TSS indeed is a dangerous disease if contracted, the risks are much lower today than they were before, due to changed production processes. But this is not something that is emphasized or communicated efficiently. People often think the risks of TSS are just as high now as they were in the 80s, which may lead to further stigmatization of menstrual products. Anna-Lisa Persson stated that,

“When people start to worry, they often bring up TSS and refer to things that were much more relevant in the 80s and that’s a pretty long time ago. So, it’s good to know that tampons have changed, not just because there are developments in the tampon industry but also because there are developments in the pulp industry.

The fact that we call it ‘the tampon disease’ is a reference that the tampons of the 80s were much worse than those sold today.”

There was a spike in TSS in the 1980s due to the process of bleaching the rayon in tampons using chlorine. Today, companies normally use oxygen instead of chlorine in the textile bleaching process, but this is not something that is commonly known. The very notion that the slang for this disease is connected to tampons can be seen as alarmistic because the majority of those who suffer from TSS, today, are not using a tampon (Friedmann & Hint, 2019). Persson continued by explaining that,

“There is an Austrian company that produces rayon for more than 70 percent of tampons globally. Generally, in Austria they have good laws and regulations, and that product should be very clean from them; it is highly monitored and controlled in all stages of the production process. So, the rayon that comes from that company is a very clean and fine rayon, which is good because in the beginning of the 1980s, the bleaching of rayon was very problematic and contributed to much higher numbers of TSS cases.”

Further, women and other menstruators experience so many issues with menstruation during their menstrual cycle, and one way to try to minimize those is by being transparent about the contents of menstrual products. The information asymmetry among established manufacturers and their consumers was one of the reasons why Peri and Hoffman decided to start their company,

Yoppie. They created a brand with the principle that all products offered would be organic, carefully sourced, and importantly transparent regarding the list of ingredients, which is rarely disclosed in other cases.

To summarize, the way in which the safety of menstrual products is communicated has a bearing on how the public perceives menstrual products, which affects their stigmatization regarding safety aspects. The greater the transparency about risks, the greater the destigmatization with regard to the aspect of the menstrual product stigma that is associated with product safety, in particular TSS. Furthermore, the ways in which product safety is communicated, today, varies in the sense that agencies are careful not to alarm the public.

However, the communication around TSS can be regarded alarmistic in the sense that every tampon package must warn about the risks, where the risk of dying is emphasized disproportionately to the number of cases of TSS today.

Looking at the statistics regarding the frequency of TSS contraction in relation to tampon use, it can be argued that the risk is slim, especially since manufacturers changed the composition of substances and materials after the TSS outbreak in the 1970s and 1980s (Cowart, 2016). Standardizing can increase transparency about the safety of menstrual products, the comfort of knowing that the products one uses are safe will likely increase, which further increases the confidence of the user. Increased confidence in association with menstruation and menstrual products, as previously mentioned, aids in destigmatization thereof.