Listening to Women: Insights on Menstrual Health
In 2015, after finishing my undergraduate studies, I worked with adolescents in Uganda as part of an internship with a Ugandan NGO implementing community-based health programs. I was struck by the fact that many girls there lacked the menstrual materials they needed to comfortably manage their menstruation, attend school, and participate in their communities. It should be an easy fix. Give girls pads. It seemed so obvious!
More recently, as a graduate student in public health, I was beyond excited when I realized I could take Marni Sommer’s “The Global Menstrual Movement” course, and work alongside her for the Gender, Adolescent Transitions & Environment (GATE) Program. Through my coursework and my involvement in GATE, I came to realize that providing menstrual products isn’t enough to help women and girls achieve good menstrual health and hygiene (MHH). It was so much more complex. Girls need the physical infrastructure (like clean, safe toilets) to support their menstruation, MHH education, and efforts to reduce menstrual stigma and shame often present in the community. Above all, I learned that girls and women need to be listened to when they share their lived experiences, in order to address their unique needs and design public health programs accordingly.
My experiences as a research assistant with GATE this spring were wide-ranging—both in terms of geography and focus area. I joined projects examining boys’ experiences navigating puberty in the U.S., promoting menstrual-friendly public toilets in urban cities around the world, studying the effectiveness of delivering puberty education through faith-based organizations in Tanzania, and exploring the intersection between Type 3 female genital mutilation/cutting (FGM/C) and menstruation in Somali communities in Kenya.
I learned about the practice of FGM/C (which in its most severe form, Type 3 or infibulation, involves a closing of the vulva that leaves a small hole for urinary and menstrual secretions) and efforts to eliminate it. The United Nations adopted Sustainable Development Target 5.3 in 2015, which aims to eliminate FGM/C by 2030. Many countries (including Kenya) have banned the practice, and public health experts have developed multiple interventions to address individual attitudes and community norms and end FGM/C. Surprisingly, I learned that very little is actually known about what the impacts of FGM/C are on menstruation—despite global attention being drawn to other health complications of FGM/C in recent decades.
Thankfully this is changing. In my role as research assistant, I worked alongside colleagues at GATE and the African Population Health Research Center (APRHC) to conduct exploratory research aimed at understanding the lived experiences of women who have undergone FGM/C and how it affects their menstruation, as well as the perspectives of healthcare providers in these communities. I helped analyze interview transcripts from women and healthcare providers, an interesting process that taught me a lot about how qualitative research is conducted across different contexts. Reading about these women’s first-hand encounters with FGM/C was a powerful exercise that I will carry with me when thinking about women’s pain and other bodily experiences.
This study, while still in progress, has highlighted for me the urgency in prioritizing respectful healthcare needs and menstrual health. I came to Mailman to gain skills in research methods and evaluation that I could leverage to discover the most impactful ways to improve the health and lives of women and girls living in vulnerable settings around the world, and this project helped me meet that goal.
My work on this project has me reflecting on the larger issue of gender inequality underlying many of the issues GATE focuses on. Gender inequality manifests in harmful social practices, taboos, disproportionate allocation of resources, women’s voices being silenced, and women’s pain being normalized. These issues are exacerbated by poverty and the systematic underfunding of health care delivery. Addressing these root causes, while complex, is crucial for creating meaningful change for women and girls. With both MHH and FGM/C, I have learned that the global public health community has a long way to go to improve health, human rights and equality of all people. Prioritizing the lived experiences and health care needs of women with FGM/C not only strengthens ongoing efforts to end FGM/C but also ensures that these women receive the respectful and effective care they deserve. In the end, it turns out most public health problems (and solutions) are more complex than they seem, but a commitment to highlighting the voices of women goes a long way.
Sarah Branoff is a second-year MPH student in the Department of Population and Family Health. This summer, she is back in Uganda working on increasing access to self-managed contraception for women living in refugee camps along the border with South Sudan.