Episode 010: Global Health Research and Advocacy with Marni Sommer

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Marni Sommer is a renowned researcher, professor and author in the menstrual health field. She specializes in puberty research and adolescent-focused interventions, gender and sexual health, and the intersection of public health and education. Marni currently leads the Gender, Adolescent Transitions and Environment (GATE) Program in Columbia University’s Department of Sociomedical Sciences: a research-based program that examines puberty-related challenges and solutions in low-income settings, and aims to improve the integration of MHH into global humanitarian responses.

Marni is also the founder of Grow and Know, an organization that empowers girls and boys going through puberty with story-based, culturally-tailored books about their changing bodies (based on research conducted in nine countries). In this episode, she talks to DfG about the challenges, learning lessons, outcomes and inspiration behind these game-changing projects and so much more. You won’t want to miss this deep dive with one of the best and brightest in menstrual health research!

Highlights:

• The origins and ongoing impact of Grow and Know
• The importance of including boys in puberty and menstrual health education
• Her work with the Gender, Adolescent Transitions, and Environment (GATE) Program – including two recent projects revolving around menstrual health and humanitarian/emergency response efforts.
• What inspired her to start the GATE Period Posse webinar series, which brings together cross-sectional MHH experts to discuss key emerging issues each month.
• The impact of COVID on period poverty and menstrual health management in low-resource contexts.
• Ongoing challenges for menstruators experiencing homelessness in urban settings and possible solutions (like improved budget allocation for period products and better administrative policies in shelters).

Connect:

• Email: ms2778@columbia.edu
• Website: Grow and Know: www.growandknow.org | GATE program: www.publichealth.columbia.edu/research/gate
• LinkedIn: Marni Sommer
• Twitter: @marnisommer

Bio: 

Marni Sommer, DrPH, MSN, RN, has worked in global health and development on issues ranging from improving access to essential medicines to humanitarian relief in conflict settings. Dr. Sommer's 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 explores 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 presently leads the Gender, Adolescent Transitions and Environment (GATE) Program, based in the Department of Sociomedical Sciences. GATE 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.

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Transcript:

Jessica Williams 0:01
Welcome to the Days for Girls podcast, a show about breaking barriers for women and girls around the world. I'm your host, Jessica Williams, Chief Communications Officer at Days for Girls International. At Days for Girls we believe in a world where periods are never a problem. We are on a mission to shatter the stigma and limitations associated with menstruation by increasing access to sustainable period products, and menstrual health education for all people with periods. Today's guest is Dr. Marnie Sommer. Marnie has been working in global health for 24 years, and conducts research and advocacy on puberty and education globally. She has a Doctorate in Public Health from Columbia University, and currently leads the GATE Program in Colombia's Socio- Medical Sciences Department. Her research with girls in Tanzania formed the basis of a book that is now an entire suite of puberty books that empower girls and boys around the world. You can check them out at growandknow.org. Marnie was a fabulous guest. And I am so excited to share this interview with you. Now, let's go on to the show. First thing I want to talk about is the Period Posse webinar series. And the work that your team is doing around that, can you for those folks who maybe aren't familiar with that webinar? Can you talk about that and how that idea came about?

Marni Sommer 1:29
Sure. So that was all the ideas sort of came out of discussions that my team which consists of management, and Caitlin Grewer were all part of the GATE team. And we have lots of great students as well. But I think we were trying to think of ways to… many years ago, I worked with UNICE on launching the MHN in schools virtual conference. And one of the things I really liked about that platform that I'm not involved anymore, is that it created a platform for people to connect, both to share what they were doing, and also to find each other in the chat box and during that annual conference. And so when I stopped doing that – and it's great, UNICEF continues to do it – and started to think about, you know, there's all these great people doing a range of different things, whether it's research or practice or policy work. And they they not only are doing great work that other people may not know about, but they also may or may not be finding each other. And so we thought about launching a webinar series each month that would speak to a range of people out there, whether they're practitioners or students or donors or researchers from the most rigorous, to those doing more practice based work, both to learn from each other whenever the topics might be of interest, and also to find each other and exchange resources, connect, exchange ideas. And so that was sort of the inaugural reason behind launching the Period Posse webinar. And I think in that first year, we weren't really sure, mind you this was all pre COVID when people were not on zoom all the time. So we weren't really sure would there be takers when people find that useful? And so we just did it as a bit of an experiment. But found in that first year, we're now midway through our second year of webinars, that we had people from over 70 countries, I think, I don't even know how many views I think it was something like 3500 views of the webinars not necessarily live but after they were posted, and the recordings were sent out. So we decided that it really did seem to be filling a gap in terms of the sharing of ideas and connecting people all who are super into all things periods as we are.

Jessica Williams 3:36
Well, I love it. I'm on your newsletter. And when the webinars come out, it really is a nice way to learn about who's who in the sector and who's doing what.

Marni Sommer 3:47
Yeah, great. Yeah. And we've also tried hard to get people from different countries, just so that, you know, we're really getting a like this morning, we had one and there was the US and Jordan and Malawi. So to us, that's like the perfect kind of webinar, because it is capturing perspectives from all over.

Jessica Williams 4:04
Yeah, that's great. So you also founded Grow and Know. And you've been running that organization for over a decade now. And this was inspired by the success of your book. And so I thought we could talk about your book and some of the work you were doing in Tanzania that led to you publishing this book, and then founding Grow and Know.

Marni Sommer 4:26
Yeah, well, actually, they happened hand in hand. I had decided I wanted to do a book for girls all about sort of their first periods, capturing their stories so they could learn older girls writing stories for younger girls. And then as I was doing the research, which was my doctoral work, I realized that a book of stories of first periods was really meaningful, but didn't answer all the questions that girls had. And so the thought was to create a book that would include both factual content, taken very much from whatever the country was already teaching or planning, combined with these first person accounts from older girls in that country speaking, as it were, to younger girls. And I was a bit naive, I had just finished my doctoral degree and thought: oh, well, I can just go do this and raise money. And then it became clear now you can't just raise money if you're not a nonprofit. So it was really a close friend and colleague, who was a girl's education expert, Jackie Kirk, who, unfortunately, we lost in Afghanistan coming home from a girl school, but she had said to me, you know, just do these books. And so that was sort of sort of the circumstances of losing her that really motivated me to figure out how to form a nonprofit. So we would have a way to raise not a lot of money. There's really no staff, we have teams who work in different countries, developing the books and partnerships with local colleagues and governments. And so the Tanzania book was the first book, which came directly from research I had done in Tanzania. And then we quickly started to hear about needs and desires for these books in other countries. And so that's what led to us one by one, doing books in additional countries, and then starting to do work with on boy's books as well.

Jessica Williams 6:09
That's amazing. Where, where can people find these books?

Marni Sommer 6:13
If you go to www.growandknow.org and go to our work on the country page, all the books are there PDFs, they're free to download, and organizations over the years, whether it's governments or un organizations or NGOs, who wanted to order large numbers of books in the 10s of 1000s, or even in the hundreds, we connect them with the publisher in the country. And then they just directly make an order with the publisher, we just make that connection, try to keep track of how many books there are, which are over 2 million now that have been distributed. And then also just like to hear like yesterday morning, I got an email which cheered me immensely in the middle of all things pandemic, from someone in Zanzibar, who had ordered us a couple hundred books, and wrote to tell me and send some photos of the girls in the schools in Zanzibar and how they were learning all about periods from the books and that it was proving to be very successful, which was great to hear.

Jessica Williams 7:06
That's wonderful. Isn't it interesting, what a difference just education can make.

Marni Sommer 7:14
Its immense. Absolutely,

Jessica Williams 7:16
Yeah. And I want to go back to what you said about also publishing books for boys and men as part of this work. So tell me more about that.

Marni Sommer 7:26
Sure. So what we found, you know, I was very fixated as somebody who had come to the issue of girls in periods, sort of worrying about the gender gap in education and girls not having enough information about their bodies. And that, so for a number of years, that was really the primary focus. And then it was actually Tanzania and mentors of mine – older women who had been working on gender for a long time, most of their careers, whether in government or other NGOs – saying to me, well, what about boys, Marni? You know, not only do they cause problems for girls, but they have plenty of their own problems. And so that really made me stop and think. And so we got some funding to do research with boys, first in Tanzania, to better understand what were the pressures they were feeling around puberty and body change, whether it's wet dreams or erections or whatever it is, and peer pressures to drink, and we learned a ton. And so we put together our first boys book in Tanzania. Now we have boys books in Kenya, Cambodia, and we're working on one in Ethiopia before the pandemic interrupted things. And the boys books, we felt it was very important to noy only have pages on their bodies and gender dynamics and the stories from boys about their experiences, but also a page on girls' body change and menstruation, because it's so clear that boys and girls and all people with periods, you know, understanding each other's bodies, and taking away the shame and the embarrassment and the stigma around all the issues that make young people uncomfortable would be a good way to make progress. And in terms of the book, the books overall, what we encourage and what we put in the books, is that young people should seek out older people they trust, to answer their questions to feel supported. We put that in the girls book, we put that in the boys book, and we're hoping that actually fathers and uncles and grandfathers are open to those conversations. I think mothers and aunties and sisters may be more actually used to having those conversations than some of the the males in these young people's lives, but we're hoping that you get a book into the home, or you get the book into the school and it starts to shift those critical sort of gender norms in society.

Jessica Williams 9:38
Amazing, I love it. Anytime we start talking about talking about bringing boys and men into the conversation, it just, it really, you know, it means a lot to me, because I think that's the only way we're going to really transform the narrative is by having everybody like feel less shame and stigma around this.

Marni Sommer 9:56
Yeah, I agree.

Jessica Williams 9:58
So Marni, you're currently leading the Gender, Adolescent Transitions and Environment Program – the short term for that is GATE – in the Department of Socio-Medical Sciences. So, tell me more about that program, what do you what are you working on?

Marni Sommer 10:14
Sure. So we we formed the program, because we realized that we had a sort of a wide body of work a number of years ago, but we thought it would be useful to have a more cohesive umbrella that would help to articulate some of what we work on. So, over the years, the reason gender is in there, is we obviously do a lot of work around sort of gender norms and issues of body change, and then, of course, we have spent a lot of time thinking about toilets and water and sanitation, and the implications of disposal and waste management around menstrual products. So that's why environment is in there. And adolescent transitions, of course, because we're very interested in understanding, you know, people's transitions through puberty and the implications, sort of taking care of their own body and also feeling supported and building their confidence and making sure they have physically and socially enabling environments around them.

So our current body of work we wrapped up just a few months ago, two projects. One was a compendium, it was a follow-on to a toolkit that we did with many humanitarian emergency partners, including the IRC is our main partner, looking at how to improve humanitarian response around addressing menstruation and menstrual management in emergency contexts. And what that then led to, with some funding to develop a compendium on menstrual product disposal, waste management and laundering, which may be the least sexy topic out there, except for people like Days for Girls who think about periods and products as much as everybody or more than most people. And so that compendium was really… although it was aimed at people working in emergencies, there's so little out there around recommendations for interventions to improve the ability for people to dispose of or launder their products, whether they're reusable or disposable, that I think the compendium is probably quite relevant across both development and humanitarian contexts.

We also wrapped up a project very recently looking at improving responses around Ebola, and menstrual hygiene in Ebola contexts, or Ebola outbreak situations, which really came from a colleague who works in Doctors Without Borders, who had asked us about two years ago, you've done all this work on emergencies. But what about Ebola outbreaks and sort of the way in which blood figures into an Ebola outbreak and there may be suspicions around menstruation. And there should be some guidance and so we came up with a… you know, after doing some research, a guidance note, again done in partnership is all our projects with the humanitarian response sector. So that guidance note was literally released about a month ago, or you know, two months ago maximum when the Ebola outbreaks had stopped. And very sadly, they just started again in Guinea and Congo this past week, so. So that's something and we're now starting to think ahead to other work we may want to try to do in emergency contexts, there's a lot of unfinished work.

Other things we're working on the last couple years… we've been working on a book for girls in the US to help low income girls better understand their bodies and feel supported. And right before or the summer before all things COVID started in 2019. We did some work in New York City exploring the experiences of those who are homeless, and sort of how they are not able to manage their menstruation with comfort and dignity, whether they're living sheltered or living on the street. So we've been writing up the findings from that and starting to present on some of the insights. And that was done in partnership with the Coalition for the Homeless, which is a wonderful advocacy organization, many decades old, that has been doing great work with the homeless all these years here in New York. There are other projects, but we do not have the entire day. To list them all out. But we're all super busy. I love it.

Jessica Williams 14:05
That's awesome. So I want to slow it down a little bit and go back to the integration of menstrual health and hygiene management into global humanitarian responses or emergency responses like the Ebola outbreak. Have you done any work around this topic as it relates to COVID?

Marni Sommer 14:28
So that's a great question. We did about trying to understand the impact of COVID on those living in low resource contexts, sort of the reduction in programming restricted access, because of lockdowns and economic fallout. We have not done that work overseas at all. We have been looking into that a little bit in the US. Just trying to understand that but nothing to report on yet. But I think from what I've been hearing from colleagues who work in other countries, that one of the great concerns they're having – and I expect Days for Girls is more familiar with this than I am – is that the gains made in girls' schooling and girls' education and girls getting into schools that were more friendly environments for when they're managing periods, to better learn about their bodies and so on, there may be some regression in terms of progress just because, understandably, COVID has taken center stage and people are staying home, because they're afraid as they understandably should be. And so just I think there's some concern that some of the progress that was being made on this issue may slow, if not reverse for a little while, as other things take center stage, but my expectation in both low and high income countries or middle income countries is that whatever, that as there is an economic fallout. So there's, you know, there's the issue of lockdown, and can you get the supplies you need? Are they available? If you're using reusables, that may be easier than if you're using disposables. And the implication of economic fallout for people in terms of what they're able to afford or not afford, whether it's, you know, again, reusables or disposables that they're familiar with, and laundry and soap.

And you know, the other thing that I was thinking about a lot last year, we actually did a Period Posse webinar back, I think it was in April or May, I can't remember, just to sort of see what people were doing in response to COVID, early on in relation to periods, was just what it means for people to be much more sequestered at home. And the issue of privacy. You know, I think one of the things that we used to hear about in humanitarian contexts (I know less of this in development context, because I didn't do this research asking) was that whole families maybe are living in tents, for example. It's when the men and boys are out of the tent that a woman might manage her period, because the latrine isn't really adequate. And so I have wondered over the last year, particularly those first few months, is people were in lockdown if they are in very confined spaces with lots of family members, for women and girls, or anyone who has their period. How are they managing? How were they managing with that loss to privacy? And, you know, I don't have an answer to that. But it is something I've wondered about.

Jessica Williams 17:20
So can you tell me more about what you learned in the study in New York, as it relates to homelessness?

Marni Sommer 17:27
Sure, sure. So we started out by talking to the coalition, because as always, we didn't want to do research that anybody who's actually engaged in this work wouldn't think would be useful. But they were very supportive and said, anecdotally, they got reports from women, those who are experiencing homelessness – not just women, there's a lot of trends, young folk who are homeless – that pad access was a problem. And they suspected, particularly for those living on the street. And one of the things that may be a bit unique about New York is there is a right to shelter that was sort of agreed upon many years ago. And so one of the things about New York is technically many, many more people are in shelters than on the street. Now, I think COVID has up ended a little bit of that, because people became nervous about being in shelters. But New York City also passed a menstrual equity legislation that was mandated to provide products for those who are in shelters in public schools, and those who are incarcerated. So we were curious to hear if that policy meant that in the shelters at least, that we could explore with interviews, if that was the case that the products were now available. But again, this was a qualitative study, it was quite small, we certainly do not, did not landscape the sort of the the entirety of shelters in New York system. But what we found were a number of things probably won't be surprising to you or the audience.

So one is the issue of toilets and bathing and laundering, and particularly for those on the street. And even for those who are maybe sheltered and in single shelters, which means it's not usually family shelters, people are in apartments. But for the single people, they're often in a either shared living space, or they have a communal toilet, that they're using our bathroom that they're using. And so we found that issues of for those in the shelter system who were sharing issues of cleanliness and feeling that the bathrooms and bathing spaces they had were adequate was problematic that oftentimes there were issues around cleanliness and having some place to dispose of products or wash their products was an issue. laundering maybe came with a cost that they were not able to afford. And then for those in the street that was really exasperated because they did not have good access to places to bathe and to change easily. The public toilets in New York, whether they're on the subway or in the park, often are not in great condition. And we did some observation around that. So the issue of toilets and bathing, there are places where you can shower in the city, but not enough from what we heard. So that was sort of one realm of challenges. Another realm of challenges we heard about was product access, in terms of products not necessarily being at all shelters, or maybe they were at the shelters that we heard about, but it was not mentioned that they were there. So people didn't, you know there is that shame and embarrassment, and there wasn't a norm around asking for them or them being provided. Or they were provided potentially in ways that were inadequate, sort of a couple at a time, and not the amount that somebody with their period might need. And I think if you try to see it from the perspective of the service provider, which we always try to do, they may not feel they have adequate budget to really provide the amount that somebody might need. And so they're trying to ration but the person being rationed, may understandably find that very stressful and embarrassing, and, and also, the quality of the products may or may not be both the thickness, or the variety, or the you know, sort of the quality, what may be available may not be what they're comfortable with, or what is adequate for their needs.

So we learned a bunch of different things, I think, you know, my students, I teach a course administration for my Master's of Public Health students, and I had them think a lot more about toilets than they ever did before. And when you start to pay attention to public toilets, and you know, parts of America that may be quite different, but at least in New York, the public toilets are really a challenge. And with COVID, that's really exacerbated because libraries are closed, public toilets were closed for a while people are very nervous about, you know, getting COVID. And so wherever people were, and the commercial establishments, whether it's McDonald's, or Burger King, or Starbucks, where people maybe were going, who were living on the street independently, not even just those who are homeless, but frankly, everybody moving around the city, those are closed, you know, that people can't walk into them and use their facilities the way they always have been able to. And so that commercial sector, which I think was plugging a hole a little bit in the city's availability is not really available right now. So that I think also has repercussions, not ones that we studied, but ones that it's easy to imagine from what we heard the summer before COVID, around issues of access.

Jessica Williams 22:36
Are there any solutions that were being talked about to help the women who were experiencing loss?

Marni Sommer 22:44
So the way we do all of our research, it's sort of embedded in our methodology is always to ask the to keep the people were researching at the center and to try to capture their stories, and also to ask them for solutions. So we did query everyone we interviewed and the service providers we talked to, and we've also done some additional work, there's a conference on administration and the law coming up in April at Columbia School of Law hosted by a variety of people, not all at Columbia, where we're going to talk about this, but I think in terms of access to toilets, probably there needs to be more and better public toilets, perhaps there needs to be someone monitoring the toilets to make sure that they stay clean, that they're safe. That may be a better way to you know, that may be a better spending a budget than worrying that a monitor costs money, but if you're having to constantly repair or upgrade, you know, so making sure public toilets are greater number better maintained, potentially monitored, things like more public private partnerships around providing toilets, because I just don't think the city could ever provide the level of public toilets that and maintain them that they need to, to meet the population. So I think there's a number of creative ways this could be addressed for sure there could be more places for them to shower, one of my students yesterday, actually after class, because I know after Tuesday's class, which was focused on this topic, sent a link with shower mobile shower units and cities like San Francisco and I think parts of La which has a much bigger Street, homeless population. And I think probably Portland as well. There's a Portland has like a can't remember what it's called. But they have, you know, one of these electric toilets, but a design that seems to be more successful than other cities. So I think there's a range of ways we could improve access to toilets, there could certainly be more showering spaces.

And then in terms of products, I think making sure that shelters and service providers have the budget to provide adequate amounts of products. You know, the someone we interviewed had this wonderful idea that everywhere…. so that you don't have to depend on a lot of the public toilets, or any toilets, don't have those vending machines that used to be in there. And even if the vending machine was in there for products, you might not have the money, but they had this great idea where if there could be, you know, vending machines in some ways and other public spaces where you could use your benefits card the same way you might or a credit card, you could maybe use both, and insert it and get products when you needed them. Because their point was, well, what if you're sleeping on the subway platform and you get your period, you know, the toilet may or may not be open, you can't go into a drugstore and get stuff. But if these vending machines are scattered throughout the city with products, and we can use our benefit cards, you know, I don't think right now the benefit system is set up to cover products, I think it tends to focus on other needs, mostly sort of nutritional, but really, they had wonderful ideas around how do you improve the dignity and comfort of people with this very natural, you know, human experience? There's nothing you can do to stop your periods. So how can we help people to be able to manage it more comfortably?

So I think there's definitely ways we can improve, from the basic of service providers in shelters having better budgets and sensitive gatekeepers who are making products available in a much more comfortable way, all the way to how can we transform our cities? So that, you know, it's not an issue for anybody? I think there isn't anybody who works on this issue of periods globally, who hasn't gotten their period when they weren't expecting it, and didn't have a product and had to figure out some kind of makeshift solution. So if there were suddenly products accessible, and all sorts of bathrooms and places, and we take away the hidden nature of it, I think that would really be transformative.

Jessica Williams 26:35
Yeah, yeah. Or we could be Scotland. And that would be amazing, right?

Marni Sommer 26:43
Yeah. But yes, absolutely.

Jessica Williams 26:46
And it's funny, because I live in Portland, and I know the toilets you're talking about. They're phenomenal.

Marni Sommer 26:52
I think it's called the Portland Zoo. I can't remember. Anyway.

Jessica Williams 26:56
Yeah, they're great. Well, this has just been great morning. I feel like we could talk for hours. You're so knowledgeable on this topic. And so I'll have to have you back on the show again, later down the road. And we can talk about what you're working on in the future. And I'm curious to see what the GATE program does with COVID. And you know, as this, this pandemic rolls on, for all of us, Marnie, if people want to learn more about your work, where should they go?

Marni Sommer 27:25
I would say they can either go to www.growandknow.org if they want to learn about the period books, or if you just Google “GATE team Columbia University,” then our whole sort of team website will pull up and you can peruse the various things we're doing and feel free to send myself, Maggie or Caitlin an email. If you have any further interest in any of the things we're working on.

Jessica Williams 27:51
Amazing. You answered my next question, which was how people can connect with you. So that's great. Are you on Twitter or anything like that?

Marni Sommer 27:58
It's @MarnieSommer, you'll see a lot of tweets from this morning's period policy webinar, which we had three fantastic speakers. So that reporting should be up in the next week. And yeah, you can find me there. I think we're on LinkedIn as well. Both the GATE team has a LinkedIn page, and I have a LinkedIn page as well.

Jessica Williams 28:17
Okay, great. And we'll put all of that in the show notes for everyone to find. Thank you so much for your time. I really appreciate it.

Marni Sommer 28:23
Sure. Thank you for doing this!

Jessica Williams 28:25
The Days for Girls podcast is produced by Days for Girls International. For show notes and resources mentioned in this episode, visit daysforgirls.org/podcast. If you'd like to support the work we do on the show, leave a rating or a review wherever you listen, subscribe to the show, and share our episodes on social media or with your friends. To learn more about days for girls and to join our global movement, please visit daysforgirls.org Thank you for listening. See you next time.