Menstrual cups are bell-shaped devices, typically made of medical-grade silicone, that are inserted into the vagina to collect rather than absorb menstrual blood. A single cup can be worn for up to twelve hours, then emptied, cleaned and reinserted, and with proper care a cup can last for as long as a decade. Compared with disposable pads and tampons, the economics are striking. One systematic review cited in the study calculated that if a woman used twelve pads per cycle, switching to a cup would represent roughly 0.4 percent of the waste and 5 percent of the cost; against twelve tampons per cycle, the cup would account for about 7 percent of the cost and 6 percent of the plastic waste. Research in Gujarat found that the average annual cost of sanitary pads is roughly twenty times that of a menstrual cup. Yet despite these advantages, usage among reproductive-age women in India has been reported at only around 5 percent.

The research team, led by Melisa Rudolph Menezes of Manipal Health Enterprises Limited, together with Swathi K S and Brayal D Souza of the Prasanna School of Public Health at Manipal Academy of Higher Education and Pallavi Upadhyaya of T A Pai Management Institute, grounded their investigation in three established behavioural frameworks: the Theory of Planned Behaviour, the Technology Acceptance Model and the Health Belief Model. This integrated approach allowed them to capture social influence, usability perceptions and health-related beliefs within a single model. The Theory of Planned Behaviour contributes the roles of attitude and subjective norms; the Technology Acceptance Model contributes perceived ease of use; and the Health Belief Model contributes safety perceptions, cost considerations and awareness as a cue to action. Because menstrual cups are inserted rather than worn externally, the researchers also hypothesised that safety perception would mediate the relationship between attitude and behavioural intention.

Data were collected through a cross-sectional online survey distributed via Google Forms and social media platforms, with voluntary participation and informed consent. The questionnaire contained 28 items measuring seven constructs: awareness, perceived ease of use, price value, attitude, safety perception, subjective norms and behavioural intention, all rated on five-point Likert scales. A priori power analysis using G*Power indicated a minimum sample of 103 for a medium effect size, so the achieved sample of 282 was comfortably adequate. Analyses were performed in SPSS for descriptive statistics and SmartPLS version 4 for structural equation modelling, following a two-step procedure that first validated the measurement model and then tested the structural paths.

The measurement model passed standard checks. Outer loadings exceeded the 0.7 threshold, Cronbach’s alpha and composite reliability met internal consistency criteria, average variance extracted surpassed 0.5 for convergent validity, and all heterotrait-monotrait ratios fell below 0.90, confirming discriminant validity. Variance inflation factors were all below 5, ruling out problematic multicollinearity. Most respondents were aged 18 to 30, about 91 percent had education at or above the 12th-standard level, roughly 30 percent were employed, and 73.4 percent were single, reflecting a largely young, educated, digitally connected sample.

The structural model delivered clear and statistically significant findings. Awareness, perceived ease of use and price value all significantly shaped attitudes towards menstrual cups, with price value showing the strongest path coefficient into attitude at 0.312. In turn, attitude, safety perception and subjective norms all significantly predicted behavioural intention. The coefficient of determination for behavioural intention was 0.424, indicating moderate predictive validity. Most strikingly, safety perception carried the highest path coefficient of any construct at 0.411, making it the single most powerful driver of intention in the model. All seven hypotheses were supported at the 5 percent significance level.

The mediation analysis added a crucial nuance. Without safety perception in the model, the direct effect of attitude on intention was 0.505; with the mediator included, it dropped to 0.246, an absorption of 0.259. The indirect effect through safety perception was 0.2558, and the variance accounted for statistic came to 0.5097, falling within the 20 to 80 percent range that indicates partial mediation. In practical terms, this means that even women who hold favourable attitudes towards menstrual cups may hesitate to adopt them unless they also believe the product is safe for their bodies. Safety beliefs about hygiene, insertion, sterilisation and leakage act as a cognitive filter through which positive attitudes must pass before converting into intention.

These findings align with, and help reconcile, a mixed international literature. Studies in Taiwan using the Theory of Planned Behaviour found attitude to be the largest predictor of cup intention, while research in the Philippines reported that subjective norms did not significantly influence intention, and work in Nepal suggested that positive peer exposure could increase adoption. The Indian results suggest that in a context where menstruation remains stigmatised and misconceptions about internal products persist, social endorsement matters, but it cannot fully override personal safety and comfort concerns. Prior Indian studies have reported that more than 80 percent of women in some populations are aware of menstrual cups and nearly half would be willing to try one if available, yet actual use remains low, evidence that knowledge alone is insufficient to change behaviour.

The authors argue that their results point to targeted, actionable interventions rather than generic promotion. To address safety perceptions and ease of use, policymakers and marketers could develop instructional workshops and video demonstrations on proper cup use and hygiene. Given the influence of subjective norms, peer-led campaigns and community ambassadors could normalise the product, while digital campaigns on popular social media platforms highlighting health benefits and cost-effectiveness could raise awareness. The study is not without limitations: its cross-sectional design cannot establish causality, convenience sampling through online channels may introduce self-selection bias and limit generalisability to women with less internet access or digital literacy, and measured intentions may not translate into actual behaviour where product availability, peer influence or personal comfort intervene. Even so, the research provides public health experts, policymakers and marketers with an evidence-based map of the psychological levers, above all safety, that must be pulled to make sustainable menstrual health choices genuinely accessible in India.

Subject of Research: Behavioral intentions of Indian women to adopt menstrual cups as sustainable menstrual hygiene products

Article Title: Shifting Preferences: Assessing Women’s Behavioral Intentions to Adopt Menstrual Cups

Article References: Menezes, M. R., K S, S., Upadhyaya, P., & Souza, B. D. (2026). Shifting Preferences: Assessing Women’s Behavioral Intentions to Adopt Menstrual Cups. Trends in Psychology. https://doi.org/10.1007/s43076-026-00533-8

Image Credits: AI Generated

DOI: 10.1007/s43076-026-00533-8

Keywords: menstrual cups, menstrual hygiene management, behavioral intentions, Theory of Planned Behaviour, Technology Acceptance Model, Health Belief Model, safety perception, PLS-SEM, India, sustainable menstrual products, consumer behavior, women's health