Menstrual Health and Hygiene as a Public Health Issue | Dr. Marni Sommer

What is Global Health?
What is Global Health?
Menstrual Health and Hygiene as a Public Health Issue | Dr. Marni Sommer
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Dr. Marni Sommer

In this episode of “What is Global Health,” Phalaen Chang (CC ’23) spoke with Dr. Marni Sommer on the importance of menstrual health and education and discussed some solutions moving forward.Dr. Marni Sommer: Dr. Marni Sommer has worked in global health and development on issues ranging from improving access to essential medicines to humanitarian relief in conflict settings. Her particular areas of expertise include conducting participatory research with adolescents, understanding and promoting healthy transitions to adulthood, the intersection of public health and education, gender and sexual health, and the implementation and evaluation of adolescent-focused interventions. Her doctoral research explored girls’ experiences of menstruation, puberty and schooling in Tanzania, and the ways in which the onset of puberty might be disrupting girls’ academic performance and healthy transition to adulthood. Dr. Sommer also presently leads the Gender, Adolescent Transitions and Environment (GATE) Program, which explores the intersections of gender, health, education and the environment for girls and boys transitioning into adulthood in low-income countries and in the United States. GATE also generates research and practical resources focused on improving the integration of menstrual hygiene management and gender supportive sanitation solutions into global humanitarian response.

Transcript (via Sonix)

Phalaen Chang: [00:00:06] Hello, everyone, and welcome to this episode of “What is Global Health?” Although awareness of menstruation has been steadily increasing, especially with social media through Tiktoks and memes, the complex issue of menstrual health often still remains undiscussed and unexplored in many low and middle income countries and even in many parts of the United States, education around mental health is lacking, leaving girls inadequately prepared to feel comfortable with the changes in their bodies. Social stigma and lack of access to toilets add another layer to the problem, often creating barriers for girls education and obstacles for their health. Today, we have invited Dr. Marni Sommer to explore this complex and important issue of menstruation as a public health issue with us and shed light on some solutions moving forward.

Phalaen Chang: [00:01:02] Dr. Marni Sommer has worked in global health and development on issues ranging from improving access to essential medicines to humanitarian relief in conflict settings. Her particular area of expertise include conducting participatory research with adolescents, understanding and promoting healthy transitions to adulthood, the intersection of public health and education, gender and sexual health, and the implementation and evaluation of adolescent focused interventions. Her doctoral research explored girls experiences of menstruation, puberty and schooling in Tanzania and the ways in which the onset of puberty might be disrupting girls, academic performance and healthy transition to adulthood. Thank you so much for being here with us today! So kind of to get things started, how were you first made aware of menstruation as a public health issue?

Dr. Marni Sommer: [00:01:57] Yeah, well, that’s a fantastic question. And I would say it was not considered a public health question or issue when I started. So when I looked into exploring this issue, I had gone back to school to get my doctorate degree. I had been working in public health, but I had had this prior life experience of being in the Peace Corps in Eritrea and teaching in a school that didn’t have bathrooms. And I mean, there was one bathroom that the teachers used, but the kids didn’t have bathrooms. And it’s one of those things I used to think about. This was like ninety five to ninety seven in this village. Where do they go? The girls walk sometimes an hour to get to school on the road in this rural area, they sit for eight hours in the way the schools are constructed in a lot of the way they’re managed in a lot of countries is the kids don’t move, the teachers move. So I was thinking: they sit in this room for eight hours. They’re squished like three or four to a bench, you know, what do they do? Do they not come? Do they wear like lots of cloth or? So I had been thinking about it in the mid 90s. I had been hearing at the time that girls never leaving school after puberty, they’re getting married, they’re not finishing.

Dr. Marni Sommer: [00:03:08] But that was just sort of anecdotal. And we were told to focus on girls as a priority because they were leaving school. So it wasn’t until 15 years later when I went back to get my doctoral degree and I was thinking, I’m in public health and what do I want to look at? And, you know, I felt very strongly about girls education. I got good education growing up. I got to go to good school. I you know, I went got to go to nursing and public health school. And so it felt unfair to me that girls were not that there was still a gender gap in the schooling. So in 2004, when I went back to school, I thought, well, let me look into that and see if there’s a public health aspect to it, because I’d really love to do something. And it was as I was looking at all the reasons that girls were not staying in school or not going to school or leaving school early or struggling in school. There was distance and fees and so on. But then there would be this occasional mention in a UNICEF report or UNFPA, which is the U.N.Population Fund report, saying, well, puberty happens or their toilets are an issue. But then when I would try to find out, well, what’s the evidence? Because I’d like to read more about that, because I had had that question 15 years earlier as a Peace Corps volunteer. I would find like these tiny little footnotes that some male anthropologist in nineteen twenty seven, like, was in a village, you know, and he thought that periods were an issue. And first of all, not enough people are talking about this because there was very little it was very hard to find any evidence when I would search in the literature, there was nothing when I would search for what we call the grey literature. So you’ve like the scientific literature and then you say literature, which was like UN reports. There was only like these random little footnotes. And so I thought, this is ridiculous. Why is why is there no data? Why do we not know what girls say? I see that the schools don’t have toilets, you know, so that’s when I started looking into and it really wasn’t that was 2004. It really wasn’t, I would say until two thousand, 12 or 13 that it started to finally gain some traction as a perceived public health issue.

Phalaen Chang: [00:05:21] And kind of, building off of that, you talked a lot about how, like menstruation affects education and on how education connects with health.

Dr. Marni Sommer: [00:05:30] Yes, of course, again, a great question. There’s this great linkage between girls education and health. And I’ll just talk about girls for today, because that’s really where most of the evidence is. We know that. And it depends on the amount of schooling. But we’ve known for decades that if girls stay in school, they are more likely to vote. And we’re just talking elementary or primary school. They’re more likely to vaccinate their children. They are more likely to use contraceptives and therefore not have as many children because they understand the benefits. They are more likely to understand the importance of nutrition and sanitation and all these things for their children. We know they are more likely to, if they have more education, be protected from HIV. They’re more likely to have a delayed sort of adolescent, you know, their first child. So we know there’s a lot of benefits to population health, to those girls themselves and to their future families if they are educated either to the primary level and some things to the secondary level. But what if getting your period knocks you out of school or makes it very difficult for you to do well in school? And there were sort of two different tracks or ways I wanted to explore that that I thought sort of had hypotheses about what was I thought, OK, well, what if, as we know and this still happens in some cultures, you get to the age of your body developing and your first period. And if you look at the anthropological literature, that first period is sort of a sign of womanhood.

Dr. Marni Sommer: [00:07:02] I mean, it’s a sign of womanhood in practically every culture. And so, you know, but it has implications for womanhood that are stronger in some places than others. And so I wondered, you know, is that first period a trigger or an indication to that community or society or ethnic group or where the girl lives that it’s time to get married or time to have a baby, which usually means you don’t get to stay in school. So I wanted to explore sort of the social cultural linkage, and we know for sure that used to happen a lot. That happens less. But I would say there are still places in the world, including in Tanzania, where I did my study, where that probably is still happening. But there’s still many parts of the world where you reach puberty, you get your period, and that is either you need to be protected because somebody might get you pregnant and that will ruin the family honor, or that’s a sign that you’re ready to get married or have children. And then there’s the more practical sort of issues that I wanted to look at, which sort of stemmed from that time I spent in the Peace Corps, which was, well, what about access? What about the school environment, the social environment and the physical environment? And by that I mean, well, the social environment. Are the teachers supportive? Are there peer support of do they understand what it’s like to manage your period for the first couple of years and or if you have bad cramps and or, you know, if you don’t have enough materials? And are teachers supportive? Do you get the information you need to learn about your bodies? Are your fellow students, girls and boys supportive and then the physical environment? You know, do you have the materials and supplies that you need? Do you have pads or good cloths? Do you have underwear? Are there toilets in that school? If there are toilets, are there enough toilets? Are they safe? Is someone going to attack you if you use them? Do they are they clean? Do they have a lock on the door? Do they have somewhere to throw a pad? If you’re using pads, do they have water or if you’re changing and you get blood on your hand or you have a blood stain on your skirt, will you be able to wash it? And if not, if none of those things are true or only some of them are true, what does that mean for girls willingness or a female teacher to go to school and she has her period to stay there the whole day and so on.

Dr. Marni Sommer: [00:09:10] And so there’s other aspects as well, like if she has cramps or, you know, is there a way for her to go rest without being stigmatized? You know, is there a potential to get menstrual, you know, to get pain medicine or is that not culturally acceptable? Or are there not nurses or people to give pain medicine? So so it’s a sort of two avenues that I wanted to explore that I think are the ways in which we think those are sort of the main ways in which we think it may impact.

Dr. Marni Sommer: [00:09:36] And then as you start to get into the classroom, you know, if you don’t have supportive teachers, you know, Will, if a girl isn’t standing up for two days, you know, will the teacher punished her, not understanding that maybe she’s and is afraid she has a stain or she has bad cramps or she’s not or she’s nauseous, you know, so I think and then the other thing that nobody talks about is that when you look at the symptoms of when people have their periods, there are a lot of women and or anyone who has their period who in the first couple of days maybe they have GI problems, you know, they have a little diarrhea or they have to go to the bathroom or, you know, no one talks about that. But what do you do if you don’t have a toilet, you know, or a toilet that you can go to when you want to and you feel safe and. It’s clean and so on, so so those are the different ways in which first education and health are so intertwined. And then I think menstruation and health intersect and education intersect.

Phalaen Chang: [00:10:33] That’s great. Thank you so much. So earlier you had mentioned how comfortable teachers were or how well educated teachers were on the subject of menstruation, could be a potential barrier as well for improving the mental health and hygiene and awareness of girls. And a lot of your work had to do with the educating of younger students, like you mentioned, making books for them. Has there been efforts towards educating teachers as well?

Dr. Marni Sommer: [00:11:01] Great question. It’s really interesting, the dynamic with teachers. When we went to Tanzania, when I was doing the research for the first time, I one of the things we always do is we look at the syllabus to see is, is puberty or is menstruation even in the syllabus. And so when we went to Tanzania in 2006 and I looked at the syllabus, it was there, it was covered first challenge. It was covered much later, like they would have been menstruating for a while by the time they learned about it. So that was challenge number one. Challenge number two is which I heard from the girls, is that the syllabus covered like the biology, you know, what is reproduction? What is your uterus, what happens in a girl’s body, what happens in a boy’s body? But there wasn’t practical guidance around that. Maybe you’ll feel this way and this is how you use a pad and, you know, this is how you stay clean. And so the practical guidance was not anywhere, you know, covered. And then the other issue that we found that we heard about is that many teachers, female teachers, were very uncomfortable talking about it. So even if it was there, they would skip it. So, you know, they might say they taught it. But in fact, when you talk to the girls, it was like it was like it didn’t exist. And so it’s a great idea to have a teachers guide. I know that, for example, in Kenya, they have a new menstrual health and hygiene policy that comes with the teachers guide, because I remember I edited it a couple of years ago.

Dr. Marni Sommer: [00:12:31] I don’t know that it’s rolling out into the schools yet, but I think it’s about there’s a couple of things teachers need to feel really comfortable. You need to make sure that sort of their cultural beliefs around menstruation are talked out so that they are teaching accurate information and being sensitized to girls needs and and they need to feel empowered. One of the things I know parents in a lot of countries where I worked are concerned about, and I think teachers feel the same way as they’re a little afraid to talk about it because they’re afraid they’re going to be asked questions they can’t answer, you know, and as the authority in a school, they don’t want to be seen not able to answer questions. So I think a teachers guide is a really important piece of what needs to happen. But the other challenge that comes up is that talking about puberty in periods may or may not be. It’s not like it’s kind of like America in some places. It’s not part of the testable curriculum. And you certainly don’t want people getting tested on puberty in periods. But when some when there’s a really strong emphasis on testing and what you have to get through, that’s mandatory. I think covering puberty in periods in a supportive way is not enough. It’s not mandated in enough places. And so therefore teachers may or may not be motivated. And so I think you have to look kind of holistically.

Dr. Marni Sommer: [00:13:55] They need to feel well equipped to do it and comfortable and confident and the school sort of educational system needs to support them doing it. And then the third issue that may come up, which certainly came up in a couple of countries where I was, is the the nature of the discipline between teachers and kids. There’s still some corporal punishment. It’s not always the most positive relationship. I mean, the same in the U.S., I think, although most places fortunately, we don’t have corporal punishment anymore. And so a teacher may or may not be who that kid is comfortable talking to. So sometimes I think you have teachers that they feel very comfortable with. Other times it may be challenging. And so I think in a perfect world, there’s like visiting teachers, you know, people who they can you know, any kid can ask a question of and not worry. They’re going to get a bad grade because they asked a question about their bodies or not feel shy, are uncomfortable with a teacher who has control over their academic success. So I do for sure. I think teachers are a really important part of the equation. And we’re working with a Canadian NGO right now in Sierra Leone that’s very works very closely with the teacher training institutes. And we’re developing pretty books there with the idea that there would be a teacher guide so that teachers and it’s going to be really interesting to see how that works.

Dr. Marni Sommer: [00:15:13] And I think they’re going to practice with the teachers sort of talking about the issue. But I think the issue of cultural beliefs is I think that practice is really critical, because one last thing I’ll say is when I was in rural towns, the girls were telling us I mean, this was 15 years ago. So I don’t know. But now that, you know, you had never told anybody we were interviewing girls. They were 16, 17, 18, and we were the first people, our little team that they’d ever told they were menstruating, and when we said, well, why is that? Three or four of the girls said, well, if I tell my mother that I got my period, she’ll die. I’m thinking, oh, that’s very dramatic, so it took me a while to figure out why they believe that the reason they believe that was teachers was the primary school teachers had told them. So it’s like you just want to make sure, you know, that you are understanding the cultural beliefs as part of that training. But I think you want to go in and understand the local culture, understand the local beliefs and come in with just to know that, like just doing a training guide is a key part of it and a very few countries have it. So absolutely, that would be a good stepping sort of first step, but that you need to do a bit more to make sure they actually are teaching on it in a way that you want them to be.

Phalaen Chang: [00:16:30] So, yeah, I’m kind of on that note, in class, you talked a lot about the books and the training guides and and what really stood out to me was an emphasis on, like making sure that the voices were from the girls themselves and making it really relevant for them. I was just wondering if you can talk a bit more about that process for people who aren’t in the class and some considerations and that you had in mind so that you weren’t like making anyone get in trouble accidentally so that people could practice it. And kind of because I know of cultures like our stigmatizing it. But you want to kind of push against that stigma a little bit like how do you balance doing that and

Dr. Marni Sommer: [00:17:07] And yeah. So I think when we when we do the research in any country, it’s critically important to us, any study we do, whether it’s girls or boys or grown ups, whoever the participants of that study, whoever the vulnerable or the population is that we are trying to understand their experience. It’s deeply important to me and my team and to many other people, I think, who do research like this, that we really hear directly from the people who are at the center of that experience. And so in this case, it’s obviously the girls in the schools in Tanzania. And so we asked them we came up with methodologies that involved a lot of anonymous writing about their first periods or ways in which they could share their stories and their experience. And not it wasn’t necessarily they didn’t have to say it out loud, because I think in particularly and I don’t think there’s any country that I worked in where the girls just we would never ask and they would never launch right away into talking about their first period, particularly teenagers, I think. And that may be shifting as more and more countries talk about the issue as it becomes more normalized. That may shift. But certainly when I was in Tanzania in 2006, that wasn’t the case.

Dr. Marni Sommer: [00:18:20] And so. When we have the girls right there, first, a story about their first period, I was just talking to somebody about the method yesterday, we separate them in the classroom. We give them a piece of paper. We tell them six times. We do not want to see their name on that piece of paper. And then they write their story and then we tell them, turn the paper upside down. We will collect the paper. And I work really hard with my research assistants to make sure they do this right. We collect the papers upside down. You know, a clever news, so curious. They immediately want to turn over. And then I yell at them across the room because we don’t want the girls to think we’re going to look at their handwriting and know which handwriting goes with it. You know, it’s all about trying to make them feel as confident as possible that whatever they’ve written on that piece of paper will never be linked to them. And we may go a little overboard. I’m sure there’s some girls who don’t care that much. But I think we want to just sort of convey this is your private story. Does it mean that there’s anything? Taboo about periods, we just want you to not feel, because oftentimes I would say the stories we get talk about feeling ashamed and embarrassed and you know that those are powerful emotions.

Dr. Marni Sommer: [00:19:31] So we don’t want them to feel outed or like we are publicizing. So I think in the data collection and we always ask their permission, we say we want to do a book for girls or if we’re doing the boys book, we do it that way. Can we use this story? One day we’re going to take a selection and use it in a book for girls in this country. We will not use your name. Are you OK with that? And they always have said they’re absolutely OK with that. I just feel badly because sometimes these are wonderful stories and they don’t get any credit for it. But but but this way nobody has to worry that their story is getting out there. And then I think the other thing around, you know, we design the books. It doesn’t always happen this way in terms of their usage to be kind of like Judy Blume when I was growing up. We all read these Judy Blume books, which are about growing up now. They’re not like our books. They’re heavier text. They’re much more in depth.

Dr. Marni Sommer: [00:20:22] But I had this idea that this book would be something a girl can read privately at home. She gets to keep the book, take it home, read it in the corner, read it sitting by the side of the road. So she has a private interaction with that, learning all about her body and reading the period stories of older girls from her country with the girls. I can’t write anything that’s going to make a girl feel empowered, but an older girl from that country certainly can. And actually my original idea was I was only going to publish a book of stories. I was going to collect stories and was just going to be a book of girl stories. And then I realized the girls have so many questions and they there’s so many things. They don’t know if it’s true or not true and you can’t get it that all through a book of stories. And so that’s why the stories became part of it. And so I think the idea is that we kind of normalize the topic. They all get these books, they share the books, they discuss it. But it’s not any one person’s own story who’s reading it. And so it sort of makes it a sort of normalized conversation.

Phalaen Chang: [00:21:22] Right. And earlier, you had also talked a lot about the lack of access to toilets or perhaps like water and sanitation are the material aspect of menstruation that is kind of maybe limiting for people with periods to think like should be done in that regard, because I would imagine that building like new toilets or something like that would be very expensive. So I was just wondering, like for toilets and access to like pads, maybe the solution was like, how do you go about that?

Dr. Marni Sommer: [00:21:53] Yeah, yeah. You know, it’s a good question. There is a as you may have picked up, if you look in the media, there is a real focus on giving pads to girls or giving reusable or period underwear. You know, there’s a real focus on the products and sometimes with information and well, for sure, lots of people need products or need better products. And it’s always felt like a very incomplete solution because without improved toilets or even a toilet, it doesn’t matter the best product in the world. You still need to be able to change it at some point and or sort of use the bathroom at some point. And so for sure, toilets cost more, but they also last longer. They’re not going anywhere, hopefully. And if you maintain them, then they last even longer. I think what we’ve tried to articulate is that. The right to sanitation is sort of a larger human right, and this just menstruation is just one more reason you need to meet that right to sanitation. And it is something that governments have a responsibility to do in terms of basic sanitation, whether it is in the schools, in the public schools, whether it is in the transport, in the like, at the bus stations, whether it’s in the marketplaces, you know, whether it’s, you know, wherever it is, the girls and women or anyone with a period is walking around in their society that there is this right to a toilet of some sort and doesn’t have to be fancy.

Dr. Marni Sommer: [00:23:23] It doesn’t have to have running water, but it needs to be safe and clean and available. And so, well, it does take an investment. You know, there’s so many health benefits, not that you should even need that. It should just be like one of those things because, you know, the number of you that would have come in that day for class if there were no toilets in the Columbia’s campus and anybody either period or not even have their period, like nobody would have shown up. But there were no toilets on campus or they would be back in the bushes and then Columbia’s campus wouldn’t look quite as pristine as it does. So I think when people stop and personalize it and identify with it and think about, well, how would that impact my daily life going about my business, I think it starts to feel like something worthy of investment. I think that the provision of pads and supplies are really important as well, particularly, for example, in emergency context, where maybe people fled their home. They don’t even have the cloths that they used and they couldn’t carry a lot. But it’s also kind of like. People wanting the magic bullet like, oh, if we just give them pad’s, they’ll be fine because it feels simple, you can count it. It’s a little bit like when people were first very focused on addressing the HIV epidemic. You know, it was all about giving out condoms, you know, not necessarily tackling.

Dr. Marni Sommer: [00:24:41] Well, what are the dynamics between men and women? What enables condom use? Who’s going to use it? How do you get it to people? But it was just you could count them, you know, as you can count pads. And I think that for a lot of the donors who maybe originate in countries like ours, they can really identify with a menstrual product. Trying to talk about toilets, you know, it’s like people even think about it because, you know, there’s always a toilet somewhere if you, you know, look a certain way, carry yourself a certain way, have a certain amount of means. You can always find a toilet to almost not always, but almost. Right. So so I think that’s why even though we do appreciate that, it does require some investment and of course, maintenance, that it’s sort of you can’t have one without the other or you can, but it’s not going to be as effective as if you think of it as like a holistic package, which we like to, which is the toilets and water and disposal along with the products, whatever they are, reusable or usable along with the information. Because if someone doesn’t understand what’s happening in their body or doesn’t feel confident or doesn’t feel able to manage their period, then having the product won’t matter either. So we like to sort of say it’s these three-pronged things that is a very basic and, you know, sort of what you need, you know?

Phalaen Chang: [00:26:00] Yeah, definitely. And I was just wondering if there’s any, like, current initiative improving access to toilets or improving the conditions to toilets, because I don’t feel like I care about that a lot. Like I often hear people advertising you reusable products. But anyway.

Dr. Marni Sommer: [00:26:15] Right. So it’s funny you say that because, you know, I had a number of interactions over the years when I was trying to get various op eds published about sort of work we were doing. And I had at least two editors write to me. I’d written an op ed that had to do with toilets. And they’re like, we cannot write about like art. We’re not like I don’t remember what it was like around Christmas once or like around some holiday. We’re not talking about toilets this time of year or, you know, it was just this like that’s not interesting. Our audiences want to hear about toilets. So it’s not and I say this to you know, I will get calls from journalists sometimes because there’s some new paper, some new movement out there, usually around products. And they want to talk about it because it gets in the news. Somebody has done another study or they have a new initiative and and they call to talk about it. And I say, well, that’s an interesting question and I’m going to talk to you. And then you can just see there, I mean, fortunate, I can’t see their face most of the time, but it’s like they’re least they’re like, “Must we?”

Dr. Marni Sommer: [00:27:10] I’m like, we must talk about toilets. It’s not sexy, but we’re going to talk about it. And happily, just a couple of years ago, NPR actually was willing. They did a piece. I did a piece they published. So they’re starting to be, I think, more openness. But I think when covid is over and you go to dinner parties, you know, you try bringing up period products and you try bring up toilets and you see where that dinner party conversation goes and which topic, if either is welcome, you know, which one’s more welcome. So that being said, it’s a great question. There are NGOs out there who are either related to the menstruation issue or totally separate because toilets have huge health impacts around cholera and diarrheal disease. And so there are many NGOs out there and donors who work on sanitation, water and sanitation is sort of the field that it’s called. It is not a well funded in comparison to other initiatives area. And it’s interesting because I was recently on a call with a huge donor that gathered a number of us to have some breakout groups and talk about, well, look, covid came people started to appreciate the importance of water and sanitation, washing your hands, hygiene, you know, are we can we capitalize on that? You know, was this our moment? And are people going to have a sustained interest in providing toilets and water? Or was it like we’ve lost them already? And I think there was a sense we’ve lost them already.

Dr. Marni Sommer: [00:28:39] But why? You know, why is it so? It was just an interesting hour long kind of brainstorm in these small groups around what do we need to do? To make this something that’s compelling to people and worthy of, you know, I think part of it is that. It requires sort of sustained investment, you can build a bunch of toilets, but if you don’t maintain them, they’ll be broken in two months and nobody’s going to use them, you know? And so I think that so. So there’s definitely initiatives. The Gates Foundation has funded a lot of work and sanitation. A lot of the donors do. But in the World Bank has some big projects and sanitation and water. But we’ve a long way to go. So it’s still, as you know, you can start bringing up the dinner parties because maybe every little bit helps.

Phalaen Chang: [00:29:24] Moving forward, if people are interested in getting involved with either research or initiatives to help raise awareness or build like toilets to help support the cause, what can they do?

Dr. Marni Sommer: [00:29:39] So also great question. I think, one, they can start to learn about the areas and who’s doing what. One thing that might be fun for people is we have this monthly period possie presents webinar series. We actually had one yesterday morning. And if you just go to period possie presents, if you just Google that and you scroll backwards through our recorded lectures, I mean, our recorded webinars from the last year and a half, and you will anybody will see the different organizations and speakers who presented. And I think it’s a really nice collection. It’s certainly not everything, but it’s a nice collection of people working on female friendly toilets, working on addressing sanitation, water, menstruation and emergencies. Working on our next one is going to be on addressing menstruation and workplace contexts. And so I think that that’s a nice way to sort of find some of the organizations that are out there. I think if this area is particularly compelling to someone and like something they want to do with their career, they should think about what gets them most excited. You know, is it most exciting to dig into, you know, what do young people learn about their bodies or not? Is it most exciting to dig into? I really love engineering. I want to get into toilets. You know, is it urban planning or is it development sort of thinking around how do we help societies create, you know, sanitation systems? Is it that I love menstrual products and I want to figure out how do we make these sustainable good for the environment, but in a way that’s culturally acceptable? So I think one of the fun things about public health and about this topic is there’s just an array of areas, you know, do they want to get involved in education and sort of helping school systems to be more supportive and enabling? So I think it’s just about finding, you know, if you pay attention to it, someone say to me once when I was talking about the idea for the puberty book before I had done the first one, and she said to me, you know, you really start to glow when you talk about that.

Dr. Marni Sommer: [00:31:37] So I think it’s about so then I was like, well, I have to do it then. So I think if you start paying attention to the things that make you glow, that you get very excited when you’re reading about them or thinking about them, then that can help guide you to figure out sort of what is your thing? Is it about donating or is it about actually getting in there and doing some of this work so great.

Phalaen Chang: [00:31:57] It’s wonderful. Thank you so sure. So if anyone is interested in learning more or getting more involved, the website that Dr. Sommer mentioned was period posse: p e r i o p o s s e. And it is a monthly interactive webinar series that brings together experts and mental health and hygiene from across research policy and practice to discuss key emerging issues, you can join their mailing list webinar and attend their upcoming webinars to learn more and get involved. Thank you for listening and have a great day.