Episode 039: The Effects of Menstrual Health on School Attendance in Kenya with Karen Austrian

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Karen Austrian is a director at the Population Council, where she leads the Council's Girl Innovation, Research and Learning Center: a global research hub that generates, synthesizes and translates evidence on adolescents to support investments that transform their lives, especially for girls. She specializes in developing, implementing and evaluating research-driven programs that build protective assets for girls.

In this episode, Karen dives into her journey in policy-driven research and programming for girls; unpacks the nuanced issue of gendered school absenteeism; shares key findings on the relationship between MHH/SRH education and body confidence; and explains why she always “lets the evidence (of the lived experiences of youth) shape the response.”

Highlights:

• How Population Council drives impact through policy-relevant research to improve the lives of vulnerable populations.
• All about the Nia Project: a study of more than 3,000 adolescent girls in 140 primary schools in Kilifi, Kenya, that rigorously evaluated the impact of menstrual health education and period products on school attendance rates. 
• Study findings on the positive impacts of MHH interventions – including equitability of gender norms; improved menstrual, sexual and reproductive health knowledge; reduced menstrual stigma and shame; and improved confidence/self-efficacy.
• The complex issue of gendered school attendance rates – and why we shouldn’t view period product distribution as a silver bullet for keeping girls in school.
• Other factors driving school drop-outs, including lack of disposable income for school fees, domestic/familial duties taking priority.
• How MHH education can serve as an access point into broader discussions about sexual and reproductive health with teen girls.
• How Girl Roster improves data collection and program outcomes through demographic tracking assistance.
• The importance of taking an integrated approach to research 

Connect:

Website: https://www.popcouncil.org/research/expert/karen-austrian

Email: kaustrian@popcouncil.org

Bio:

Karen Austrian is the director of the Population Council, where she leads the Council's Girl Innovation, Research and Learning Center: a global research hub that generates, synthesizes and translates evidence on adolescents to support investments that transform their lives, especially for girls. Prior to stepping into this role, Austrian led a portfolio of projects designed to empower girls in East and Southern Africa. She develops, implements and evaluates programs that build girls protective assets, such as financial literacy, social safety nets and access to education.

Transcript:

Jessica Williams 0:54
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.

Jessica Williams 1:25
Today's guest is Karen Austrian. Karen is a director at the Population Council, where she leads the Council's Girl Innovation, Research and Learning Center: a global research hub that generates, synthesizes and translates evidence on adolescents to support investments that transform their lives, especially for girls. Prior to stepping into this role, Austrian led a portfolio of projects designed to empower girls in East and Southern Africa. She develops, implements and evaluates programs that build girls protective assets, such as financial literacy, social safety nets and access to education. I really loved this conversation with Karen today. And I hope you enjoy it as much as I did. Now let's go on to the show.

Jessica Williams 2:09
Hi, Karen, it is so great to have you on the Days for Girls Podcast. Thank you for being here. How are you today?

Karen Austrian 2:15
I'm doing great. Thanks for having me.

Jessica Williams 2:17
Absolutely. Well, I am very interested in the work that you're doing. So let's dive right in. You are principal investigator and you work on a lot of different quantitative studies about girls and women around the world at the Population Council. And so for those who don't know what the Population Council is, can you tell us more about that organization?

Karen Austrian 2:39
Absolutely. So Population Council is an international research organization. And we have offices in about 15 different countries. And we really do a wide range of primary research, really trying to answer critical, policy-relevant questions to improve the lives of vulnerable populations. We work across a range of topics from how to improve the lives of adolescents, whether it be focusing on education, early forced marriage, sexual and reproductive health, gender equality, and more. We also have teams working on maternal health, working on HIV, sexual and gender-based violence. And The Council also has biomedical labs in New York City. And so we work on developing contraceptive and disease prevention technologies. And sometimes we work together in terms of rolling out products and things like that.

Jessica Williams 3:46
Awesome. So a lot of research, I'm gathering.

Karen Austrian 3:49
Yeah. But I would say one of the key distinguishing factors of Population Council, as a research organization, and why I personally love working for it, is the purpose of the research is to have an impact. And so we really focus on research questions that are critical for policymakers – program implementers. And we really see it as part of our mission not just to generate the evidence, but to also synthesize it and communicate it in ways so that those outside the research worlds are able to use it.

Jessica Williams 4:24
Yeah, like organizations like Days for Girls. So let's dive into the most recent study that you worked on in Kenya. Can you set the stage for this trial?

Karen Austrian 4:36
Sure. So, we have been doing for over a decade now (almost two decades) work on…using rigorous research to understand what programs work best for girls. You know, it's very clear that there is no one single intervention that is going to be a silver bullet to address all the range of issues that girls face, right? So it's going to take more than one small thing to make sure that girls go from being children to young women in a way such that they are safe, educated, healthy, productive, not pregnant if they don't want to be, not married if they don't want to be, in school. And so a lot of our work has focused on these combination studies where we're looking at different packages of programs and trying to identify how that works. So that's sort of what our work has focused on.

Karen Austrian 5:32
And, you know, it's been really a pleasure for me to be able to lead the team working on these kinds of studies and trials in East Africa region. The context for the Nia trial is that I think there was there's been a growing movement in the MHM world – menstrual hygiene management, and menstrual health management – and trying to really understand the links between menstruation, access to sanitary pads, how that fits in with broader comprehensive sexuality, education, how that links into education outcomes, etc. And, you know, I think it's one of the common sort of notions, or sort of things, that are… almost like people say, without really knowing where that particular point of information came from, it's like assumed to be true: that girls miss school because of menstruation, in particular, because they don't have access to sanitary pads. And so when we were approached by ZanaAfrica, who's really been a leader in this space of MHM, and thinking more broadly about the needs of adolescent girls, and how MHM fits into those pictures, to come in and do a really sort of gold standard, rigorous randomized control trial, to try to answer these questions in the context of their program in the coast of Kenya. So we were very excited to be able to partner with them. They've been a great partner in terms of, you know, a lot of organizations aren't always excited about the idea of being rigorously evaluated. And so what we did was we set up a trial that had four sort of packages, essentially, that we were testing, and we were able to look at them one against the other, as well as against the control group, which is really a group that is getting no extra intervention. So if you want, I can describe a bit more details about the study and how we set it up.

Karen Austrian 7:33
Yeah, absolutely. And I just want to pause and say, I do find it really interesting. You know, there's a lot of qualitative data out there, stories and hearsay, and you know, what we hear in the field kind of thing. But, you know, I have heard this from several of your colleagues that I've actually interviewed, like Julie Hannigan, which is that we actually need the quantitative data that really allows us to measure and evaluate these solutions on the ground. And so I am really fascinated about this and the outcomes for this. And so, when you went into the trial, what was the hypothesis that you had and the methodology for executing this trial?

Karen Austrian 8:15
And I'll just say, I agree,. When we designed this trial, which was back in 2016 is when we were doing the design, there was very little quantitative data about the relationship between access to sanitary pads, you know, access to menstrual health education, and school outcomes. A lot of it, as you were saying was qualitative. And it really was the right moment in time to start to set up this trial. And so what we wanted, the questions that we wanted to answer was to say, what is the impact of regular distribution of high quality sanitary pads on girls school attendance? What is the impact of, you know, a comprehensive sexuality education program? That included a strong component around menstrual health management, addressing sort of taboos and stigma around menstruation. So what is the impact of that program on self self esteem, gender norms and some other health outcomes? And then is there sort of an added benefit to the two of those things happening together: when girls have regular access to sanitary pads, and are participating in this comprehensive sexuality education program? And so we had four what we call sort of “arms” in the research world. Or they're essentially program packages that we delivered. And we worked in 140 schools in three sub-counties in a coastal county in Kenya. It's called Kilifi County and it's quite rural. And we chose that place because there's a lot of sort of school dropouts amongst girls – a lot of teenage pregnancy in that particular area. And so we had, of the 140, we basically divided those schools. We randomly assigned them into four groups.

Karen Austrian 10:14
One group of schools, basically, didn't get any additional program. So what they had going on was the standard government issued sanitary pad program, which – although there is a policy that girls are supposed to be able to access pads – we know that the supply chain is very sort of infrequent and disrupted. So maybe they'll get there, maybe they don't. And, you know, we saw basically at baseline, when we started the trial, before the program started, only about 20% of girls said that they had enough sanitary pads to properly manage their menses each month. So that sort of gives you a sense of the level of quality and regularity of the government program. The government also has sort of what they call Family Life Education, and those that it is about sort of some basic life skills, some health education, but it's definitely not as comprehensive as what was offered through the Nia program, it definitely didn't have the piece around addressing menstruation, stigma and taboos. And it didn't really have this sort of more open, positive, you know, encouraging of questioning and exploring that was part of the Nia teen curriculum. So that was really what we call the control or the group that we were comparing against.

Karen Austrian 11:37
Then we had one another group of schools that were – those girls got regular sanitary pads. So each month, they got one pack of sanitary pads. And they also got underpants, because sometimes that is a problem, that girls don't also have enough underpants. And so it makes using the sanitary pads difficult. Then we had a third group of schools that got the Nia teen curriculum. It was five sessions each school term, 25 in total. And it ran the range of like I said, there was a strong menstrual health component around sexual and reproductive health, around leadership, gender norms, self confidence. And there was also a unit around, a little bit around economic empowerment, helping girls to think about how to save how to set financial goals, etc. And then there was the fourth group of schools, that got both the sanitary pad distribution and the comprehensive sexuality education.

Karen Austrian 12:39
And that allowed us to answer the questions of saying, what is the impact of each one of them on their own, compared to the group that got nothing? And are there added benefits to when they those two program, components are being offered together? So we offer the program. And ZanaAfrica was really the lead, they were the ones leading the program implementation, they worked in partnership with Plan International's Kilifi office. We were the research partner, and we worked with – so there were about 3500 girls in the research sample to start with, across the 140 schools. But it was 25 girls in each school – although all girls who were in class, seven in each one of those schools, was eligible to participate in the program. And so the program started when the girls were almost halfway through class seven.

Karen Austrian 13:33
So in Kenya – let me just back up for a second. Primary school is for eight years. So it starts in class one, up to class eight, and then the girls can transition into secondary school or high school. And so these girls were in their second to last year of primary school. And the reason why we did that is because a bulk of the dropout happens as girls, you know, they'll complete primary school, but they don't go on to secondary school. And so we wanted to catch girls sort of in that window before, as they're nearing the end or completing primary schools so that we might be able to see if there's any impact on that transition to secondary school. So the program ran for five school terms. So basically all of class seven…sorry, the second two terms of class seven, two out of three terms, and then all of class eight. The program wrapped up when the girls finished primary school and we interviewed the girls before the program started. And then we were regularly collecting attendance data throughout that 18 month period to look at school attendance, both girls and boys in the study schools. And then we came back and we did another interview at the end of the program, after the girls have completed primary school.

Jessica Williams 14:56
Awesome, fantastic. Okay, so thank you for setting the stage for all of that. When you completed the work, how many years did you say it took for this trial to run?

Karen Austrian 15:08
So the full trial was from 2016 to 2019. Because that gave us time for the formative, we did some formative research: designing the study, designing the intervention. The baseline study was done at the start of 2017. And then the program started in or around May, June 2017. And ran all the way through to the end of 2018. And we did our endline in November, December of 2018. Okay, we actually did a very short follow up in March of 2019. To follow up with the girls, just to find out if they had gone on to secondary school. But we didn't want to wait to do the endline. Because in Kenya, it's very common for girls and boys to go into boarding school for secondary school. And so we were worried that our whole panel would be scattered across the country, and then we'd have a really hard time.

Jessica Williams 16:00
That makes sense. Okay, so what do you find? What do you have for us?

Karen Austrian 16:09
Let me start with the good news. So what we found was that the comprehensive sexuality education really had a strong impact on a range of items. So we saw that girls who participated in that program had more equitable gender norms. And this was on a number of different measures. So thinking about sort of gender roles amongst adolescents, gender roles within marriage. The girls who participated in the comprehensive sexuality education had much better scores on gender norms, so more gender equitable attitudes around gender roles amongst adolescents, within relationships for adolescents, within marriage, etc. And this is something that is not always that common. And I think it really speaks to the strength of the curriculum of the Nia teen program. It speaks to sort of the the quality with which it was implemented, as well.

Karen Austrian 17:15
And we also saw improvements in sexual and reproductive health knowledge pretty much across the board. So menstruation knowledge, fertility knowledge, HIV knowledge, STI knowledge, contraceptive knowledge. So we saw improvements in those areas. We also saw improvements in self efficacy – so girls feeling more confident that they have the ability to solve problems, reach their goals, and things like that. And then finally, we saw that the girls had felt better about menstruating. So they didn't, you know, feel that same sense of shame or stigmatization around menstruating. That, you know, it wasn't a dirty thing, they didn't have to feel embarrassed about it, etc. So those were pretty strong across the board outcomes for both groups where they were getting that CSC training. And one thing that was interesting is that we saw that the effects were much stronger around the menstrual health attitudes, or sort of that improving stigma around menstruation for girls who were in that combined arm. So the girls were also getting sanitary pads. And I think that makes sense when you think about it. So on the one hand, they're in these groups where they're getting messages reinforced that there's nothing wrong with with menstruation. And on the other hand, they actually have the products with which they can manage their menstruation, so that they're feeling physically more confident about the experience. And that combination together really seemed to help girls out in that sense.

Karen Austrian 18:59
What we didn't see is that distributing sanitary pads on its own improved girls school attendance. And, you know, I think that, to be honest, it wasn't a surprise. And I'll tell you why. And I think because the reason why girls miss school, the reason why girls drop out of school, is more complicated than then just missing one or two days of school a month from because they're menstruating. And, you know, when we ask girls what's the main reason why they're missing school, why they're dropping out of school, a lot of it has to do with the economic situation that girls are in – or more accurate to say that their families are in. So the cost of sending them to school, whether it be the transport, the uniforms, the school fees that need to be paid every term. Or whether it's the opportunity cost to the family of having the girl at school as opposed to having her at home, helping to take care of it. People who are, you know, maybe sick at any given time, needing to help with agricultural work, and things like that. So I'd say that seems to be the main reason driving why girls are missing school. Another common reason I'd say…two other common reasons are maybe around the value that's placed around education by girls, families, less so by girls themselves. And then also teenage pregnancy is an issue slightly as girls start to get a bit older.

Karen Austrian 20:30
And so I think that, you know, in reflecting, it's almost doing a disservice to girls when we try to position sanitary pads as a product that will address girls education challenges. And I think that the MHM movement has moved away from that. But I do think that, you know, it's an easy adage to go back to like, well, if we give girls school pads, it'll help keep them in school. It's sort of one of these truisms that I think we just need to push ourselves as a community that's really working on menstrual health, that's working on wanting to improve girls health and well being, that it's going to take more. Now I want to say loud and clear: I am not saying, and nobody in our in our study team is saying, that like girls shouldn't be given sanitary pads. It should be seen as a right, pretty much in my opinion, full stop. It should be seen as a right and they should have access to these pads. And also, you know, it helps them better manage their menstruation and feel better about these things. And that is no small sort of accomplishment to feel better about your body, feel better about the menstrual process, not feel like something is stigmatizing, etc. I think we just need to be careful of conflating sanitary pad distribution with a girl's education solution or program. And that really, I think, what we concluded from this trial, is that MHM – both the education around it and sanitary pad distribution – is a critical piece of comprehensive sexuality education, and should be seen as a package of things that girls need as they really make that transition through adolescence.

Jessica Williams 22:20
Yeah. You know, I read this trial. So I kind of knew the end results. And already answered one of my questions, which was like, what are the implications of these findings for the menstrual health management sector? And I like that you said, it's not that menstruation isn't a challenge in some parts of the world, right? It's just not the only problem that exists, right? And how, if you assume that that's the only problem, then you are just doing a disservice to women to girls. So what what were some of the other reasons that you found that girls were missing school, that could have implications for how we empower adolescent girls?

Karen Austrian 23:07
Sure. So I think a common reason is that girls were needed at home to take care of siblings, they're needed at hom,e maybe to take care of other people in the household that were sick, to help around the household. That was a common set of reasons why girls miss school. And then I would say the other one is that girls being sent home because their fees haven't been paid. So maybe they start school, the school gives them a little bit of grace, they attend for a little bit, and then they say, Okay, you still have a balance. Until your family pays off these fees, you have to go home. I'd say those are the two most common issues that kept coming up. What I was saying about the implications of this program, and really framing MHM – both the education part of it and the sanitary pad distribution part of it – sort of as a critical piece of comprehensive sexuality education. And I think one of the things that's actually even a advantage to doing that is that often, talking about menstruation with girls is not as sensitive – or it's much less maybe controversial – than talking about if you say like, oh, well, we want to talk about sex. Or we want to talk about family planning, or teenage pregnancy with with girls. And so using MHM as a window into broader sexual and reproductive health topics, I think is a really smart strategy – both at the community level, at the household level, and even in schools, right? It's not a threatening thing to come in and say, okay, like, this is what's going on with your body. Here's how you manage menstruation, here's what it means. There's no reason to feel ashamed about it. That scene is a very a much more neutral topic than some of the other topics that might come down the line. So by starting with that, you build trust from a program coming in perspective. It allows you to build trust with the schools, with the girl's parents, with the community. And so I think sort of seeing MHM as this intro window into broader SRH is a really effective program solution. And I think it speaks to why the CSC component of the Nia trial had such strong effects, because it came in through that MHM lens. And so it was just a really well received, well accepted program for the schools, which tend to be quite conservative, and the families that the girls were part of.

Jessica Williams 25:56
Yeah, okay, great. Right. And we have to acknowledge that this is one study in one part of the world. And so we have to keep that in mind. But I know that you have also done some other studies or been a part of other like meta analyses, examining the relationship between sanitary pad distribution and reproductive health education on attendance in school. And so are these findings from the Nia trial consistent with those studies that you've done?

Karen Austrian 26:24
I do think they're consistent. Again, I think you'll see, you know, maybe slightly different results in different parts of the world. I think one of the key things is: what is the driver of girls missing school? And that might be different in different contexts. And if there is a context where it really is because of lack of access to sanitary pads, then the results, perhaps might be different in something like that. But I do think more broadly, in the MHM world there, especially in the research world, we are moving away from this metric of school attendance as like, the key metric of focus. And really wanting to focus more broadly on broader sort of health outcomes, well-being outcomes.

Jessica Williams 27:08
Got it. Okay, so let's pivot and talk about some of your other work. So as part of your work at the Population Council, you also provide technical assistance on girls programs and policies to places like the World Bank and the Nikkei Foundation and the UK Department for International Development. And so I'm just kind of curious what kind of policies and programs that you've helped work on maybe one in particular that you're most proud of?

Karen Austrian 27:33
Sure, yeah. So um, as I mentioned, part of our remit at Population Council is not just to conduct research, but to also work with key consumers of data and evidence around how to take insights that come out of out of these studies. Not just ours, but sort of broader studies around adolescence, for example, and also how to use other types of data to inform their programs. So we've done quite a bit of work. So I'll give one example. It's called the Girl Roster. It's a tool that we use often, when we're providing technical assistance. And it's more like a quick and dirty tool that programmers can use to just get a lay of the land, or understand really, what is the full set of girls that are living in the community where they're operating their program? Because often what happens is that the most vulnerable girls don't get reached by a particular program, or policy. But you don't know unless you know. For example, what proportion of girls in your community are out of school, or what proportion of girls in your community already have a child? You don't know if your program participants reflect that reality.

Karen Austrian 28:53
So for example, in the past year, we've been providing technical assistance – over the past two years – to a program in the Kiabiu slum in Nairobi, Kenya. It's a program that is called Secure Futures. It's run by a local group called [inaudible]. And it's supported by Women Win, which is a Dutch group, and it's specifically really for parenting and pregnant teens. So girls who are either pregnant or already have a child, and we worked with them to to use this Girl Roster to first get a sense of, you know, what's the profile of pregnant or parenting girls in this community. And then when they did their first round of recruitment, what they found was that the girls that showed up in the program were mostly 20 to 24 years old. But from doing the Girl Roster, we knew that, you know, at least a quarter of the girls in that community that had a child were between the ages of 15 and 19. And those are girls who are – if you think about the context of what it means to have a child, being 15 to 19. Having a child puts you in a much more sort of state of risk, or being more vulnerable. The likelihood that you have dropped out of secondary school is higher. And so we really use that data together to…go back and do more recruitment and to say, why is it that the younger sort of pregnant or parenting girls aren't coming to the program? How can we do a better job to bring them into the program, to make sure that we really are reaching the most vulnerable? So that's one example of how we we've used this sort of data approach to program design and tools, with some of the programs that we've used.

Karen Austrian 30:45
Maybe I can give another example on a policy level. So we…over the last year since the COVID-19 pandemic started in Kenya, because we have this wide body of research…in addition to the new trial, we have trials in three other counties in Kenya. These are cohorts of adolescents that we've been following for some time. And so we were commissioned by the Executive Office of the President to do a study, to really understand the impacts of COVID on adolescents, you know, in terms of social health, education, economic outcomes. And so we leveraged those cohorts, we really worked with the Office of the President, with the policymakers, to understand what are your key questions? We made sure that our surveys were answering those key questions. And we've spent the past year working on that study, collecting data, and then supporting that office to understand the data and really develop a set of recommendations for investments in adolescents – with a particular lens around gender, around equity, based on the data that was coming out of that report. And so there was a lot of back and forth around, you know: Oh, we should recommend ABCD, and pushing back and saying, Well, you know, what in the data makes you think that? That that would be the right response? And then say, Okay, well, maybe not. And so really, sort of supporting them through that process of really taking an evidence-based approach to setting the policy agenda for investments in adolescents in Kenya. And sort of as we continue, I think when we started, we thought it would be the COVID recovery period. I think we're now learning to use this sort of as the pandemic goes on, and hopefully eventually we'll enter a recovery period as well.

Jessica Williams 32:40
So my last question is, you've done a lot of interesting work. And before joining the Council, you co-founded and directed the Binti Pamoja center. Can you tell us more about that program? Because that's also very interesting.

Karen Austrian 32:57
Yeah. Um, so Binti Pomoja is a program for adolescent girls in the Kibera slum of Nairobi. It's part of a broader organization called Carolina for Kibera that does a lot around health care and youth empowerment in Kibera. And I think, you know, that really grew from a small project – working with a small set of girls to understand, you know, what were the challenges that they were facing in their lives? And then how could we design a program that supported them across these different challenges? So I directed that center for about two years, and during that process, brought in Kenyan women to co-run the center and ultimately take over the leadership of the center. And it exists to this day, it's almost 20 years old. But I think sort of what has stayed in my current work from that experience is, you know, one: the value of really just listening to adolescents to understand the challenges that they're facing, and then designing solutions around that. So sort of letting the evidence shape the response, I think is a critical piece. And the other is really just understanding how integrated all of these issues are. And I think too often in the world of global public health or international development, it's very siloed. Right? So we're either thinking about education, where we're thinking about health services, or we're thinking about vocational training or economic empowerment, or we're thinking about violence, but really all of those things, you know, a in the lived experience, none of those things don't happen sort of in buckets, right? They're they're linked together, but also the causes of them and the reason why they're challenges in these various areas are often related to similar root causes: social and cultural norms, poverty, access to opportunities, things like that. And so thinking about responses from an integrated perspective as well, is really something that has sort of, I think, driven the research that I've been involved in, and the type of lens that we like to bring to our work and conversations with and around adolescent girls.

Jessica Williams 35:19
Awesome. Well, gosh, you're just doing so many, so many interesting things. And I'm really excited to continue to follow your work. Karen, if people want to connect with you and the work that you're doing, learn more about it, how can they find you?

Karen Austrian 35:34
So I confess, I'm not particularly great at social media, although it is a goal for me to one day get onto it. I like just old-fashioned email, and you can email me at kaustrian@popcouncil.org. And I'm usually quite responsive on email. And then to check out the Pop Council website. You know, there are pages around the work that our office is doing in Kenya more broadly, the work that we're doing around adolescents, the Council also has the GIRL Center, which is – I have colleagues doing similar work all over the world, sort of nearby in Ethiopia, and Tanzania, but also in Bangladesh, and India and Guatemala and Mexico. And so the GIRL Center really brings together all of that work and looks for sort of, how do we synthesize and communicate the full body of work on adolescents? So you can check out the GIRL Center website as well. And then I have a page on the Pop Council website if you specifically want to look at the particular studies that I've been doing and the resources related to that study. That's a great place to find it all.

Jessica Williams 36:43
Awesome. Well, thank you so much for coming on the show today and giving us a deep dive into the research that you've been doing. It's really exciting to have – I know it's the menstrual health management sector really needs more data and research. So it's fantastic and thank you for being on the show.

Karen Austrian 37:01
Thanks for having me. It's been a pleasure.

Jessica Williams 37:04
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.