This is the English version of the homesite of the research project Emergent Un/Sustainabilities of Care: The Global Political Economy of the Adult Incontinence Pad.
The project is based at Global Health and Development, Faculty of Social Sciences in Tampere University, and funded by the Academy of Finland (grant #321972) and Kone Foundation.
What we do
The adult incontinence pad is a mundane commodity that is used, worn, and disposed of by hundreds of millions of people everyday across the world. Yet, very little is known about its circulation in the global economy – which is what our project seeks to understand.
The adult incontinence pad is not simply a gendered question of disgust, shame, or public expense – as it tends to be protrayed in public discourse. Rather, it is a globally productive economic field imbued with political and ethical tensions, which need be solved for the future of care to be sustainable.
The project begins with the recognition that the adult incontinence pad is never just one thing. Instead, each pad has various parallel realities.
The pad is technology, as well as an everyday commodity for different user groups – men as well as women; young as well as old; people who wear the pads themselves, and people who use the pad when providing incontinence pads for others; institutional care providers, both public and private, are important “user groups” too, for this mundane commodity and health product.
Locally as well as globally, the pad is also a site of economic inequalities and a privilege to use.
Furthermore, throughout its life-cycle, the adult incontinence pad both produces waste and is waste.
In this project, we examine the global political economies in four“pad realities” (technology, commodity , the pad site of inequalities, waste), and see what kinds of challenges of sustainability emerge as these realities entangle with one another.
How does, for instance, the technolological development and marketing of the pads account for the lived realities of different pad users?
Whose voices are heard, and why – whose experiences remain silenced? How does urban infrastructure account for the needs of adults who live with incontinence? How is pad waste managed in different societies – and is there a role for circular economy?
How does the pad industry work, together with different stakeholders, to reduce the ecological burden that this disposable hygiene product has across the world?
How is adult incontinence managed in contexts where disposable products are not available, or they are too expensive to use?
How do these different challenges of sustainability entangle with one another, and how can they be solved, together with the different stakeholders?
In close collaboration with different interest groups, the project locates the ethical challenges in the global pad industry, with the aim of co-imagining socially, economically, and ecologically sustainable solutions to them.
Bringing attention to silenced and marginalised knowledges of adult incontinence in both global north and global south, the project seeks to reduce the stigma attached to living with the condition.
Throughout the project, we organise multi-stakeholder workshops, both as a means of data gathering and dissemination – and are interested in collaborating with you. Want to get involved? Do get in touch!
Why is this important?
The destigmatising power of knowledge
It has been estimated that up to 400 million people in the world live with urinary incontinence, and up to 6 % of those under 40 suffer from faecal incontinence. Altogether, one in ten people living in the community may suffer from both urinary and faecal leakages.
Often, these conditions cannot be completely cured – or information on cure is not readily available – which makes continence management products such as the adult incontinence pad a widely used mundane commodity.
Despite its wide prevalence, adult incontinence remains as one of the most stigmatising health problems. Due to the stigma, we know very little about the world of incontinence pads. Yet, exactly due to the stigma, adding lay knowledge about the world of incontinence is important.
Knowledge makes matters of incontinence less of a myth, easier to talk about and, consequently, gradually less stigmatising. It may also make care, cure and information on options of managing incontinence more accessible.
Namely, the stigma has an impact on health services too. Even though incontinence is common, matters of incontinence remain marginalised in the training of different health professionals. Consequently, they might not always have the knowledge to provide adequate continence advise on treatments – or management products alternative to the pads. (See e.g. a comprehensive portal to choosing the right product here .)
Such lack of knowledge within health professions can normalise pad usage, even in situations where treatments or more suitable products are available.
In addition to the social and medical aspects of the stigmatised condition, there are also other reasons why we should know more about the world of the adult incontinence pads.
A rapidly growing global industry
The world of adult incontinence is not just about stigma. It is also about a range of alternative, or mutually complementary, solutions to treat and manage the condition – from physiotherapeutic to surgical interventions to drugs. All solutions aim to help people live good lives with incontinence.
The incontinence pad (i.e. “diaper”, as in the sometimes infantilising speech, or “absorbent material”, as in technological jargon) is perhaps the best known and most widely used product for continence management. And its usage is growing, globally.
In both mature and emerging markets, the transnational pad industry grows rapidly and constantly. The worldwide sales of adult incontinence pads are estimated to grow from 9.2 billion USD in 2015 to 14.7 billion in 2021. The growth has to do with the ageing of populations across the world, but also with innovation, new product families, accessible pricing, reduction of stigma and so on.
The rapid growth of the global pad markets means many things. It means that more and more people will have access to this hygiene product, which helps them manage their condition better.
The growth in the value of the sales also means that there is a wider variety of products and pad technologies available – some more expensive and higher tech than others – which may allow for a more sophisticated and effective continence care. The increase in variety also means that people may more easily find the products that suit to their particular body form and leakages.
On the downside, the growth in pad usage may also be an implication that alternative means of cure and care are not adequately considered.
Simultaneously, the growth in the worldwide pad sales means that more and more money in the world is used for buying pads – and also that more and more money is made through pad sales. This in turn means that, on aggregate, the households living with issues of incontinence are likely to spend more money on pads than before. Similarly, public spending on pads tends to increase in states where incontinence products are publicly subsidised.
Elsewhere, someone profits, and capital accumulates. Some of the profits are invested back to research and development, as well as to charity, and more or less taxes are paid too. Yet, the worldwide pad sales impacts the accumulation of capital in complex ways – not only through the pad companies, but also through financialised actors involved in the distribution of the pads, such as for-profit care providing companies and the insurance sector.
Isn’t it interesting – to see how the global circulation of the pads entangles with the complex webs of finance and global circulation of money!
That 400 million people in the world live with adult incontinence, and many use pads to manage the condition has, in other words, a massive impact on the global political economy. And we need to know more about this impact, so that it becomes possible to intervene in ways that the impact is more just and sustainable – socially, economically, as well as ecologically.
The ecological burden
The growth of the worldwide pad sales inavoidably adds to the burden of waste that the humankind accumulates on the planet everyday. While there are washable pads also for adults, the growth in pad sales refers particularly to disposable products, that do not compost.
And each disposable pad produced, sold, and used adds to the mountain of waste that is challenging and still often impossible to get rid of in ecologically sustainable ways.
In the era of climate and environmental crisis, it is here that the need to know the world of the pads is most urgent – and the concern should be shared by different interest groups, despite their sometimes conflicting interests.
The need for co-produced knowledges
In collaboration with different actors in society, the large pad companies are already involved in a range of projects that address the difficult questions of pad usage – from stigma to ecological sustainability and the question of pad waste.
Solutions are sought from circular economy, for instance, which addresses the whole life cycle of the pad, from production to usage to disposal and, importantly, recycling.
The pad companies’ efforts to create a more sustainable future for incontinence care is not to be ridiculed, or underestimated.
They are powerful actors, with a great potential to contribute to better and more sustainable continence care. Indeed, their contribution to these aims is crucially important, and in this project we hope to collaborate with the big companies, too.
However, large stock listed companies as they are, they arguably operate on commercial interests that are tied to pad sales. Hence, the search for a more sustainable future cannot be left for the pad companies alone.
Imagining a more sustainable future for incontinence care necessitates the involvement of all kinds of interest groups, even if there may be tensions between their interests.
Aware of the tensions
The search for a more sustainable future needs to account for the views and practices of a whole variety of stakeholders: from the pad users to carers and different health professionals regardless of professional hierachies; from public and private institutional care providers to those responsible for the public infrastructure of waste managament; from the big pad companies to the start up world.
Such actors – and more – all participate in the day-to-day reality, where the present global political economy of the pad is made. If we want to make that global reality more sustainable, all these actors need to be accounted for.
This is not an easy task, since the world of incontinence care is full of tensions and conflicting interests, many of which return to the questions of stigma, unequal distribution of resources and profit-making, and environmental concerns.
These tensions need to be accepted for what they are: conflicts. Conflict, however, is not a negative thing, but an integral part of human life as well as a site that necessitates negotiation over and across opposing views.
In this project, we are aware of tensions and conflicting interests that have to do with our research – and indeed each of us holds views of our own. Yet, the very aim of our research is to understand the tensions more thoroughly and from several perspectives. Only after that it maybe possible to disentangle the tensions, for the joint interests of sustainable future.
That said, even if you would not agree with all that is said on this website, but are interested in our goal of sustainable continence care across the world, do get in touch. We appreciate your views, and want to count them in. This is important.
This is us. If you have joint research interests, and want to be affiliated with the team – or are interested in conducting PhD or MA thesis project on the themes of our project – please do not hesitate to get in touch.
Dr. TIINA VAITTINEN (PhD) is the PI of the project. She is presently a Senior Research Fellow at Tampere University Faculty of Business and Managament. She is a political economist and transdisciplinary social scientist, who is specialised in mapping complex global political economies of health and social care, from the micro-level of everyday life to the macro-level of international and transnational politics. This requires leasning about the phenomena under scrutiny across disciplinary boundaries, translating between different professional jargons, and finding common ground(s) for conversation. She’s a bit lazy at updating her personal websites, LinkedIns and CVs and such. You can, however, read about Tiina’s past doings here. Sometimes, the list is up-to-date. Together with Anna Rajala (see below), Tiina also (co)authors articles under a joint alias Annastiina Rajala-Vaittinen.
Dr. EVELIINA ASIKAINEN (PhD) is a Senior Lecturer in the Tampere University of Applied Sciences. She worked in the project from September 2020 to May 2021, as a co-investigator in the work package that focuses on the pad as waste, and the possibilities of future circular economy. Eveliina’s contribution to the project was made possible by the Kone Foundation grant, and she continues to collaborate with the project in the form of coauthoring, for instance.
Dr. CHRISTOPHER CHATTERTON (PhD), worked in the project as a Postdoctoral Researcher, from November 2019 until November 2020, looking at experiences of living with incontinence. His work with us was enabled by the Kone Foundation grant. Presently, Chris works with a charity led project called “The Pad Project UK”, which co-incidentally has a similar name to our project. The two projects are not connected however. Chris still keeps in touch with us, and we look forward to future collaborations.
TUULIA LAHTINEN (RN, MA) is a (self-funded) PhD Candidate in Public Health. Her PhD thesis is a mixed-methods study, where she researches the barriers and solutions to the prevention and treatment of post-partum incontinence in Finnish maternal clinics. Tuulia worked in the project as research assistant in 2021-22, assisting the project in data collection. She also conducted her MA thesis research as part of the project. In her thesis in Nursing Sciences, she surveyed the public pad provision practices in Finland, comparing regional differences and inequalities in prescription quality and access to the products. Tuulia continues to collaborate with us in the form of coauthoring. Tuulia is also Registered Nurse and Public Health Nurse by training, and has professional experience in public services responsible for the provision of continence products and other medical supplies.
DR ANNA I. RAJALA (PhD) is Academy of Finland Postdoctoral Research Fellow, who leads her own project on the politics of defecation in Tampere University Faculty of Social Sciences, and collaborates with the Pad Project on joint articles and papers. Anna is a physiotherapist by training, and holds a master’s degree in Philosophy, Politics and Economics of Health (UCL, 2013) and a PhD in Humanities (University of Brighton, 2021). Her PhD thesis is a philosophical criticism of physiotherapy ethics through the work of the German critical theorist Theodor W. Adorno. In her previous postdoctoral research she explored physiotherapy discourses on dementia, economy, and politics, and the ‘affective politics of statistics’ in dementia research. Her interest in pads and (in)continence stems both from her clinical experience and research interests, which include philosophy, politics and ethics of health and illness, medical humanities, continental philosophy, and political economy. Together with Tiina, Anna also (co)authors articles under a joint alias Annastiina Rajala-Vaittinen.
DR MINNA TÖRNÄVÄ (PhD) is doctor of Health Sciences, specialist in sexological counselling and a pelvic floor physiotherapist. She collaborates with the Pad Project as a co-author of articles. Minna is a clinical expert of incontinence and other pelvic floor disorders, and is interested in the prevention and early intervention of these conditions. In addition to the Pad project, she works on various research projects on sexual and reproductive health.
CO-CREATING KNOWLEDGE ABOUT HOLISTICALLY SUSTAINABLE CONTINENCE CARE TISCARE2022 is an international multistakeholder workshop, organized by the Pad Project together with the World Federation for Incontinence and Pelvic Problems (WFIPP), at Tampere University 25-26 April 2022. We bring together continence care experts in social, political, economic and health sciences, put them in the same …
“The ecowelfare state should be a welfare state designed for leaking bodies.” The first research findings published The Pad Project team has just published its fist research results, as part of a Special Issue that deals with the ecowelfare state. The open access article is titles “Shadowing the shadows of the ecowelfare state: Listening to …
The PI of the Pad Project, Tiina Vaittinen, partipated in the International Continence Society Ethical Committee work in writing a white paper on ethical considerations in older adults with urinary incontinence. The white paper was published in Neurourology & Urodynamics, and it can be freely downloaded from the below link, which leads to the …
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