Blog domain: Health
Over eight weeks, VOICE brought together master students and practitioners from across the Global North and South to explore frugal and bottom-up innovation. As part of the programme, participants learned to write for a wider audience: getting an idea across quickly, clearly, and in their own voice. The blog below is the result, grounded in local conversations and shaped through weeks of collaborative writing.
From laughter to shared experience
During a village awareness session in India on 2nd July, 2026, the initial reaction to the discussion on urinary leakage was laughter, with several women covering their faces in embarrassment. After a brief pause, one participant spoke up:
“Why are you all laughing? I have this problem. Every time I go to a social gathering, I wear an extra pair of underwear because of urine leakage…”
The atmosphere changed. Following her disclosure, many of the women who had initially laughed also acknowledged experiencing similar symptoms.
This interaction demonstrates how stigma often masks lived experience. That moment revealed something important: silence does not mean absence. Sometimes, laughter, avoidance, and embarrassment are the only socially acceptable ways of hiding a deeply shared experience. https://www.linkedin.com/in/sayantika-das-7aa30812a/
Every morning, millions of women wake before sunrise, care for their families, work all day, and contribute to the workforce, often placing the needs of everyone else ahead of their well-being. A tea-garden woman worker spends hours bent over harvesting leaves before returning home to complete household chores. A woman in a crowded city neighborhood manages both her job and her family with little time to think about herself. In rural communities, women walk long distances carrying water while silently enduring their physical discomfort. Their strength is admired, but their health is often ignored, even by themselves. Hidden behind these stories is a condition that rarely becomes part of everyday conversation, not because it is uncommon, but because stigma, misconceptions, and silence surround it. Despite being highly prevalent and affecting women across all age groups, it remains a neglected public health concern: involuntary leakage of urine. In science, this condition is referred to as urinary incontinence (UI).
Many women believe that urinary incontinence is a normal consequence of childbirth or aging, while others avoid discussing it because they feel embarrassed or fear being judged. As a result, many women continue to adapt their daily routines instead of seeking medical advice or support. The greatest burden of UI is not only the leakage itself but also the silence that prevents women from seeking help.
This issue raises an important question. Is urinary incontinence merely an overlooked issue within certain societies, or does it represent a much broader global health challenge? The hundred-dollar question: Is this silent struggle unique to one country, or is it a challenge shared by women across cultures, healthcare systems, and geographical boundaries?
“I do have a urine leakage issue while sneezing and coughing, and yes, I also avoid drinking enough water. These things no one asked before....” - Women from West Bengal, India
The Hidden Struggle Beyond Borders
Urinary incontinence affects millions of women globally and remains one of the most neglected women’s health conditions despite being both prevalent and treatable. Although often perceived as an individual or age-related problem, the evidence suggests that urinary incontinence is a widespread public health concern that transcends geographical, economic, and cultural boundaries. In India, studies estimate that 10–42% of women experience some form of urinary incontinence, particularly after childbirth and during older age. Yet many continue to suffer without treatment because of stigma, poor awareness, and limited access to affordable healthcare. In India, women described avoiding water and concealing symptoms from colleagues because they feared how others might respond. One workplace manager reported discovering the extent of the problem only after a urinary-health awareness programme created an opportunity for women to speak.
This pattern is far from unique to India. In the United Kingdom, specialist services may be more established, yet embarrassment, delayed help-seeking and pressure on health services can still separate women from timely support. Nearly 14 million people live with bladder-related problems, but only a small proportion of women seek professional help despite linking their symptoms to childbirth. More broadly across sub-Saharan Africa, the most consistent risk factors for UI are parity, vaginal delivery, obesity, chronic cough, constipation, and age. In South Africa, the challenge includes strengthening recognition and first-line management within primary healthcare. A woman may reach a clinic for another reason without ever being asked about leakage. Nurses and community health workers are often closest to women’s everyday realities, but they need the time, training and appropriate tools to begin these conversations sensitively. In Colombia, almost one-third of women experience urinary incontinence, yet nearly 70% never discuss it with a healthcare professional. Here, limited access to specialists makes affordable conservative care and community-based rehabilitation particularly relevant. These examples, drawn from countries with vastly different healthcare systems and socioeconomic contexts, reveal a strikingly similar reality: urinary incontinence remains underreported, undertreated, and largely invisible.
Across countries, the reasons and constraints may differ from high treatment costs and lack of specialist services to cultural beliefs or embarrassment, but what connects these settings is the gap between the existence of treatment and women’s ability to reach, trust and continue using it. Women silently adapt their daily lives instead of receiving timely care, often restricting social interactions, avoiding travel or physical activity, and compromising their quality of life. Consequently, a manageable health condition gradually becomes a long-term physical, psychological, and social burden.
The challenge extends beyond patients to the healthcare system itself. A Western Cape study of primary healthcare practitioners, nurses and physicians, scored their knowledge and practice at 66.7% and 68.9% against the NICE (2013) guideline, with clear gaps in screening, follow-up, and use of bladder diaries. This suggests that even where healthcare services exist, early identification and evidence-based management of urinary incontinence remain inadequate.
The extent of this hidden burden is perhaps best captured by those who work closely with women every day:
"I have been managing around 450 women workers since 2018. It was only during this awareness programme on women's urinary health that we realised more than 50% of the women from our mill are silently facing challenges related to urine leakage..." - Human Resources Manager of a manufacturing unit in semi-urban India
This testimony underscores an important reality: urinary incontinence is not merely a clinical issue but also a workplace, productivity, and quality-of-life concern. Recognizing this hidden burden is the first step towards developing affordable, accessible, and context-specific solutions—an area where frugal innovation has the potential to make a meaningful difference.
The Cost of Silence
So, what do you think the consequence is, only urine leakage? The real scenario will tell you that the answer is “no”! Urinary incontinence extends far beyond urine leakage. Women frequently change their daily routines by carrying extra clothing, using improvised absorbent materials, locating nearby toilets before leaving home, avoiding travel, limiting physical activity, or withdrawing from social and religious gatherings. Many experience skin irritation, urinary tract infections, disturbed sleep, anxiety, depression, and reduced self-confidence. Families also bear financial costs through repeated purchases of disposable continence products, while employers and healthcare systems experience productivity losses and increasing service demands. Although effective first-line treatments such as pelvic floor muscle training, bladder training, lifestyle modification, and behavioural therapy already exist, they are often underutilised because women either delay seeking care or cannot easily access trained specialists. The problem, therefore, is not simply the absence of treatment; it is the gap between available healthcare and the women who need it most. Closing this gap requires solutions that are practical, affordable, culturally acceptable, and capable of reaching women where they live rather than expecting every woman to reach specialist healthcare facilities.
Why Frugal Innovation
This is where the knowledge that we got from the VOICE platform, the knowledge of frugal innovation, offers a different way of thinking. Frugal innovation is often misunderstood as producing something inexpensive. In reality, it focuses on maximising value while using limited resources, creating solutions that are affordable, accessible, user-friendly, sustainable, and designed around community needs. Rather than replacing existing medical care, frugal innovation strengthens healthcare delivery by making proven interventions easier to access. For urinary incontinence, this could include pelvic floor exercise applications available in regional languages, SMS reminders to improve treatment adherence, reusable and affordable continence products, AI-assisted screening integrated into primary healthcare centres, teleconsultations through digital platforms, community physiotherapy programmes, low-cost biofeedback devices, and awareness campaigns delivered by community health workers. Instead of asking women to travel long distances for specialist care, these approaches bring healthcare closer to communities while reducing stigma, improving early diagnosis, and encouraging women to seek help before symptoms become severe.
In India, community-based healthcare workers such as ASHAs or in South Africa, creating a practical model to train nurses can integrate urinary incontinence awareness and early screening into existing maternal and women's health programmes. In the United Kingdom, despite a well-developed healthcare system, increasing demand on the NHS has encouraged greater interest in community continence services, pharmacy-based screening, digital pelvic floor coaching, and reusable continence products that reduce both healthcare costs and environmental impact. Colombia offers another important lesson, where low-cost conservative treatments such as Kegel exercises, bladder training, biofeedback, and community-based rehabilitation are being explored to overcome shortages of specialist services. Across these diverse settings, one message is consistent: effective solutions do not always require expensive technology. Instead, success depends on designing innovations that fit local cultures, healthcare systems, available resources, and the everyday realities of women's lives. A solution that is clinically effective but inaccessible cannot truly improve public health.
From Silence to Solutions
Women’s health has remained underfunded, under-researched, and structurally overlooked across countries for far too long. While progress has been made in areas such as menstrual health and reproductive care, conditions like urinary incontinence continue to receive limited attention despite affecting millions of women worldwide. Solutions to urinary incontinence are frequently designed for women without creating enough space to design with them. The future does not depend solely on developing new medical technologies; it also depends on redesigning healthcare systems to be more inclusive, affordable, and person-centred.
Frugal innovation provides an opportunity to achieve this by involving women, who already possess detailed knowledge about what managing leakage requires. They know which daily activities are most difficult, which products fail, what makes a clinic interaction uncomfortable and what would help them speak more openly. Their lived experience is therefore not merely a source of personal testimony. It is a form of design knowledge.
By bringing together local insights, community involvement, digital tools, and resource-smart design, high-quality, accessible, and affordable care can be provided, avoiding unnecessary complications or expenses. However, collaboration will only become meaningful when women are treated as active participants whose knowledge can change the proposed solution. Co-creation also helps prevent well-intentioned innovations from introducing new burdens.
And when all is done the success needs to be measured. Frugal innovation can help us move from asking, “How do we make a cheaper product?” to asking, “How do we build a dignified route into care?”
That shift matters.
Though the success of an intervention should not be judged only by how little it costs or how many women receive it. We should also ask whether women feel safe discussing their symptoms, whether the intervention fits their daily lives, whether they can continue using it and whether it restores their freedom to work, travel, sleep, exercise and participate socially.
Above all, urinary incontinence should no longer be viewed as an inevitable consequence of being a woman. Nor should women be expected to organise their lives indefinitely around a treatable health condition. It should be recognised as a treatable public health condition that deserves attention, dignity, and investment.
Further primary research should focus on developing and evaluating context-specific frugal innovations, such as low-cost screening tools, culturally appropriate digital health solutions, community-based care models, and sustainable business approaches, which can be integrated into existing health systems and scaled across diverse settings. When women no longer have to choose between silence and seeking care, frugal innovation will move beyond isolated solutions to become a sustainable strategy for improving women's health.
Its true success will not be measured by reducing costs alone, but by equitable access, restoring dignity, and giving every woman the confidence to speak about her health in her own voice.
The woman who stayed behind after an awareness session expressed the challenge clearly:
“Madam, you came in the morning and discussed urine leakage. I couldn't tell everyone that I have this problem because I was worried about how my colleagues would react. It is very bothersome. Please suggest what I should do…” - Women, West Bengal, India
A stronger system of care begins by ensuring that she does not have to wait until everyone else has left before she can ask for help.
Participant Bios
Dr. Sayantika Das, Ph.D.
Dr Das is a Postdoctoral Research Fellow in the Department of Design at the Indian Institute of Technology (IIT) Guwahati, India, conducting research on innovative product design and implementation in women's healthcare domain under the mentorship of Prof. Sougata Karmakar. Her expertise includes ergonomics and human factors, healthcare design, occupational health, rehabilitation ergonomics, and industrial safety, supported by substantial research and teaching experience.
Angie Hernández
Colombian MA candidate in Development Studies at the International Institute of Social Studies, Erasmus University Rotterdam. Her professional background spans research, consulting, and program management across Latin America and globally, with experience at organizations including GOAL USA, A Piece of Pie, and IPA. Her research interests include development, gender, critical AI studies, social innovation, and Political Theory.
Carlton Matingo
Munashe Carlton Matingo is a PhD candidate in Industrial Engineering at Stellenbosch University, South Africa. Originally from Zimbabwe, he has pursued a journey from engineering to innovation research, shaped by a desire to understand how practical solutions emerge and endure in resource-constrained African contexts. Alongside his research, Carlton works in international credentialling and quality assurance in education, supporting assessment and external moderation processes.
Prof. Suman Phalswal
Suman Phalswal is an Assistant Professor specializing in Strategic Management and Entrepreneurship. She completed her FPM from BIMTECH and researches grassroots and frugal innovation. Her work has been published in Scopus-indexed journals, with a strong focus on innovation, sustainability, and inclusive entrepreneurship.
Lydia Lampiri
Lydia Lampiri is an international development practitioner and researcher with experience across global health, humanitarian response and climate resilience. She holds an MSc in International Development Practice from the University of St Andrews and a BSc in Political Science from Leiden University. Her interests include health systems, climate resilience, humanitarian policy and the intersection of evidence, policy and practice, with field experience in Malawi and research experience across Southern Africa.