Enablers and barriers to menstrual cup adoption among reproductive-age women: a qualitative study exploring the lived experiences of users and dropouts and perspectives of non-users from Eastern India

Menstrual health and hygiene (MHH) is a fundamental component of women’s reproductive health and human rights, yet uptake of sustainable, cost-effective menstrual products, such as menstrual cups (MCs), remains limited. This study aimed to explore the lived experiences of MC users, and dropouts and perspectives of non-users to identify enablers and barriers influencing MC uptake and sustained use. An inductive qualitative phenomenological study was conducted among women aged 18–45 years. Purposive, maximum-variation sampling was employed to recruit current MC users, former users (i.e., dropouts), and non-users. In-depth interviews were conducted in participants’ preferred language (Odia, Hindi, or English) using a semi-structured guide. Interviews were audio-recorded, transcribed verbatim, and translated into English. A total of 14 participants-six MC users, four non-users, and four dropouts (two complete dropouts & two mixed users/partially dropouts) were interviewed. Data were analysed using inductive thematic analysis following Braun and Clarke’s six-phase framework. Ethical approval was obtained from the Institutional Ethics Committee of Siksha ‘O’ Anusandhan (SOA) University, Bhubaneswar. Menstrual cup adoption is a dynamic process involving consideration, initiation, adaptation, and either sustained, intermittent, or discontinued use. Dissatisfaction with sanitary pads, perceived benefits of MCs, and exposure through social networks and social media facilitated consideration, whereas concerns about insertion, pain, infection, and limited anatomical knowledge hindered initiation. Among adopters, practical difficulties during early use were progressively overcome through experience and individualized support, resulting in greater comfort and confidence. However, inadequate privacy, water and sanitation facilities, cleaning and sterilization requirements, and household and sociocultural constraints contributed to intermittent use or discontinuation. The findings were organized into four thematic domains: menstrual hygiene management and menstrual flow concerns; physical comfort; awareness and social influence; and long-term and sustainable use of menstrual cups, encompassing key enablers and barriers to adoption. MC adoption and sustained use are shaped by a complex interaction of knowledge, social networks, physical infrastructure, and prevailing cultural norms, rather than by individual preference alone. Public health measures should extend beyond awareness-raising to promote informed choice, provide individualized support during the initial cycles, ensure culturally responsive communication and affordable access to MCs, and improve privacy, water availability, and WASH facilities to facilitate feasible and sustained use.