SEGMENT 1: Menstruation: it’s something half of the world’s population experiences. Yet having the right resources — access to period products and health information about menses can prove elusive for some due to financial concerns, lack of communication and openness on the topic due to stigma, or cultural and religious considerations.
Our topic with Nemours Children’s Health adolescent medicine specialist, Dr. Robyn Miller is period equity — and how to achieve it.
Nemours Period Pantry Amazon Wish List
SEGMENT 2: Here we share a profile of Duffy’s Hope, an organization serving at-risk teens in Wilmington, Delaware. Duffy’s Hope provides teens with one-on-one mentoring, tutoring, financial literacy, educational and enrichment trips, etiquette training, school and home visits, inspirational guest speakers and group discussions.
Learn more about Duffy’s Hope.
Guests:
Robyn Miller, MD, Interim Division Chief of Adolescent Medicine and Pediatric Gynecology, Nemours Children’s Hospital, Delaware
Allen “Duffy” Samuels, Founder, Duffy’s Hope, Wilmington, Delaware
Producer, Host: Carol Vassar
EPISODE 55 TRANSCRIPT
Carol Vassar, podcast host/producer:
Welcome to Well Beyond Medicine: The Nemours Children’s Health Podcast. Each week we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you are here, let’s go.
MUSIC:
Let’s go, oh, oh. Well Beyond Medicine.
Carol Vassar, podcast host/producer:
Kotex 1946 Educational Film:
There’s nothing strange, no mysterious about menstruation. All life is built on cycles and the menstrual cycle is one normal and natural part of nature’s eternal plan for passing on the gift of life.
Carol Vassar, podcast host/producer:
That’s a clip from a 1946 educational video from Kotex regarding a rarely talked about topic of the time and a topic that even today carries with it stigma: menstruation. It’s something half of the world’s population experiences, yet having the right resources, access to period products, and health information about menses can prove elusive for some due to financial concerns, the lack of communication and openness on the topic or cultural and religious considerations. On top of all that, many U.S. states still tax period products as luxury items. Period equity and how to achieve it is our topic today with Nemours Children’s Health Adolescent Medicine Specialist Dr. Robyn Miller. She joined us on the Nemours podcast truck in Wilmington, Delaware, recently to discuss period equity, what it is, how we can talk more openly about it, and strategies to ensure that no person needing period products ever goes without. Here is Dr. Robyn Miller.
Dr. Robyn Miller, Nemours Children’s Health:
Period equity or menstrual equity is a global term that helps champion patients being able to have access to period products, have access to information regarding menses that’s more equitable. Since this is something that your body’s supposed to go through, there’s nothing you can do about it. It’s natural. You’re supposed to have periods, and so we want to make sure you’re able to manage this natural process that happens to half the world’s population.
Carol Vassar, podcast host/producer:
Let’s address the stigma right off the bat. There’s a stigma around this. I grew up with it. You probably grew up with it. Talk about where we stand today in terms of stigma. Just talking about one’s menstrual period, about getting that on a monthly basis, starting at 13, 14, 15, or even younger.
Dr. Robyn Miller, Nemours Children’s Health:
Yeah, even younger. So yeah, that stigma is still present. I think some families have done a good job of trying to combat that a little sooner, and so they’ll have discussions about periods and be open. But I’ll take a step back and Adolescent Medicine here at Nemours, what we do is a lot of menstrual management. And so all day, every day I see girls that have prolonged periods, short periods, absent periods, painful periods, everything you can think of.
And so what I’ll see is that some family members, it’ll be three generations of women in the household, and nobody knows what’s happening with each other. They have no idea that a period’s not supposed to last a month at a time or it’s not supposed to cause you to change your pad every hour because it’s not talked about with what their mom does or what their grandmother does. And some families do talk about it all the time. They know exactly what’s happening. They know when it started. They know if it’s painful. They just know when they’re due, when the last time they had it. Mom could tell you the schedule just like they could tell their own schedule. And so it varies. It runs the gamut. And so I think there has been movement, but there are definitely still pockets of populations where it’s just something that’s not talked about.
Carol Vassar, podcast host/producer:
In families, do the cycles run similarly? So, would I have a cycle that runs similar to my mother’s? Would I have possibly similar issues like pain, like longer periods? Is there a generational or hereditary aspect to that?
Dr. Robyn Miller, Nemours Children’s Health:
So sometimes. Sometimes, that definitely can be the case. Sometimes, people have bleeding disorders, and they cause them to have very heavy, prolonged periods, and so that it’s passed down to their children. That’s not the common way that things happen. Sometimes, people still just follow, and other times, it’s the complete opposite. Parents will bring their daughter in because they’re like, “They’re super painful, and she’s bleeding all over the place. I never experienced anything like this. It just doesn’t seem normal, and so I wanted her to be checked out.” Or their periods are pretty absent, or they’re coming every other month, and they say, “This isn’t normal. It’s supposed to come every month. I haven’t had any issues. Something’s wrong.”
And most of the time, nothing’s wrong. You can skip a period here and there, but what we’re taught in schools is that periods come, the last five days, they come every 28 days, and aren’t that big a deal. They’re not super painful. You might have a little bit of cramps, you bleed a little bit, and that’s it. When really it’s this gamut that happens where I call them, it runs from baby periods to monster periods and everything in between. And that’s what we aren’t prepared for. People don’t learn about the gray zone when it comes to periods, if you will.
Carol Vassar, podcast host/producer:
So it’s being taught in school, when it’s being taught in school is being taught to this very narrow average, if you will.
Dr. Robyn Miller, Nemours Children’s Health:
Yes, that’s a great term for it. That’s exactly what’s happening.
Carol Vassar, podcast host/producer:
And so learning that your period is not going to be like your best friend’s or like your mother’s is part of, it’s normal.
Dr. Robyn Miller, Nemours Children’s Health:
Correct. Yep. That’s the education process that needs to change a little bit to allow for this gamut to be there and know that where you fall on the continuum and when there’s an issue that needs to be addressed. I’ve had patients that have bled for months, three months at a time, and they are buying products, but they still just don’t understand that this is abnormal because it’s not really talked about. And so in fairness, sometimes that’ll be a mom or a dad that is busy and juggling multiple jobs and things like that. And so things just slip through the cracks. And after kids get to be a certain age, you expect them to have a little bit more autonomy with their health and tell you when things are different or wrong. They just don’t know sometimes. And it makes it hard. Parents and adults have to understand that there is this knowledge gap that can happen. You have to ask a little bit more questions and understand and do a better job of teaching our kids what to expect when it comes to their periods.
Carol Vassar, podcast host/producer:
How do we change the education around one’s period and one’s menstrual cycle? We’ve got the stigma that’s already really strong here. How do we change the education around this?
Dr. Robyn Miller, Nemours Children’s Health:
Yeah. I think that education should start a little earlier. I don’t know what age they start doing education in schools for this, but at least at home, you could start your period at 9 or 10 years old. And so I’ve had patients that started their period, they didn’t know what was happening. They’re just bleeding from the vaginal region. They go upstairs, they lay down and cross their arms over their chest because they thought they were going to pass away at night. And when they wake up, they’re still there, and they’re like, “Oh, okay, I’m not dead.” And then they go tell their parents that this has happened. And so letting people understand that it can start early. And so preparing them.
Some people, I’ve had patients who thought that they’ve gotten their period, and yes, they’ve achieved womanhood or whatever, and it’s done. And they’re shocked to know that it comes back every month, and they don’t want it every month. They just want it once. They have some knowledge around things, but it’s not complete. I think another way to help with the stigma is to include everyone, not just patients that will bleed vaginally, but guys as well, to know what periods are. And it’s a natural, normal thing that happens to take away the stigma. We’ve all had the thing where you’re in elementary and middle school, and you have to go to the bathroom to change your pad or tampon, and it’s stuffed down in your pocket or you hold it discreetly in your hand so nobody sees it or you’re scared to go because you don’t want people to know, so you just sit and you end up having accidents because you’re not changing as often as you need to because you don’t want people to know that you’re on your period.
And so doing that education for guys as well, it’s super helpful. I’ve heard wonderful stories of some little boys having sisters who’ve had their period, and they’re on a bus, and they notice that a girl has a stain because she’s had an accident. And they’ll so nicely and politely whisper to the girl that there’s something there and hand them their jacket so she can wrap it around their waist. And so it’s indiscreet and they don’t embarrass them, and they’re so in tuned to know how devastating that can be for them. And so it’s a win-win for everyone to have this knowledge and education.
Carol Vassar, podcast host/producer:
Are there different approaches to the education within the family depending on cultural background, religious background? Talk about that.
Dr. Robyn Miller, Nemours Children’s Health:
Absolutely. And so there are, and I’m no expert on, these different cultures or religions that happen, but it’s definitely that nuance there. There are certain cultures that come to the office and the father or the male in the room is the only person that you speak to that makes decisions. There are other cultures where the men have nothing to do with that part of medicine or that part of the body when it’s GYN health. And so it is hard to know for certain, and it’s a good practice to ask what the culture is or who you should talk to or what happens at home. Some religions and cultures have special cleaning processes that happen when it is that time of the month. Some people are a little bit more isolated and don’t sleep in the same space as people when they have their periods. And again, this is just anecdotally from me being with patients and learning on the fly, and by no means an expert on this, but I do understand that based on your home life could really change what you’re exposed to and what the expectations are around menstrual health.
Carol Vassar, podcast host/producer:
Let’s talk about period equity, menstrual equity. And a young girl, a woman, young woman walking down the aisle to buy product. Product can be confusing. It’s expensive. Are there situations where there are young women, teenagers perhaps, can’t even buy the product? Talk a little bit about that.
Dr. Robyn Miller, Nemours Children’s Health:
Yeah, yeah. The first point of it being so confusing is super valid. I don’t know the last time if any of our audience listening has tried to go and buy period products, but there are so many different lines. There’s no longer light, regular, and heavy. They’re number 1’s, 2, 3, 4, 5. You have ultra thins, you have maxis. It’s like a smorgasbord of options for you. You have menstrual cups, you have menstrual discs. It’s so many things and it’s hard to know what you need. It’s hard to know what you actually use. When I talk to patients and I ask what they’re using, they have a really hard time. They oftentimes resort to the color of the packaging and Always is doing a great job. A lot of people are using Always, and so they’ll say the colors and I know what that means. But outside of that, it’s hard to know. There are more natural products that like Honey Pot and things like that. And so all of those things make it very confusing.
And the pricing for things are pretty expensive. And so they will run a package of pads or tampons around $8 to $10. And depending on what your flow is, that might last you a long time, it might last you a week. And if you have a heavy flow or prolonged flow, you might need two boxes of pads or two boxes of tampons to really make it through. And that adds up. And it’s happening every month. Or when you’re young, within those first two years of having your period, anything goes. And so you can have a period every other week for a week, and so you’re bleeding equally. Sometimes people are bleeding more than they’re not bleeding, and you have to manage that. You have to buy these products.
What started my interests in thinking about period equity was when I had a patient who came in and I get them often. The parents come in and say, “I want you to talk to her about how to manage her periods and do well with her hygiene.” And so my typical advice is that when you go to the bathroom, you just change your pad or your tampon, whatever you’re using, no matter how often that is, so that way you don’t get stuck in having it for a long period of time and having hygiene issues from that. But this particular family was living in a shelter at this point in time, and so that meant that their finances were not the best and they couldn’t afford to just waste products to change it every single time she went to the bathroom.
And I had to think of something else, which was, I knew we had period pantries that existed, but when I Googled to give them information of where to go to find this period pantry, I couldn’t find it. I found ways for people to donate to the period pantry, but not to actually for patients to receive products. After that, I was like, “I deal with periods all day every day. Why don’t I just start a period pantry?” And so that’s what happened. We have a period pantry now so we can give products to our patients because it’s really hard to counsel on those types of things. And all periods aren’t created equal and it’s hard to manage it financially as well.
Carol Vassar, podcast host/producer:
How would you define a period pantry? Is it like a diaper pantry or a food pantry? Similar to that-
Dr. Robyn Miller, Nemours Children’s Health:
Yeah, it’s very similar. And so we try to have products of all variety, and so we have tampons of all sizes. We have menstrual pads of all sizes in the interest of Mother Earth and period equity and period poverty. Reusable methods are oftentimes very key. And so we have menstrual cups, some menstrual discs which are reusable. It’s a learning curve with them, but they can be used over and over and can be a great method for patients. We have period panties that patients can use. And so oftentimes you need more than a few pairs to get through a cycle, but then your upfront cost is it, and you don’t really have to change unless you grow, which teenagers are doing, so you will have to swap them out. But oftentimes it makes it so that the cost is a little bit more palatable and not having to buy large packs every month for things.
Carol Vassar, podcast host/producer:
Let’s talk about the policy side. I know in California, and I understand also here in Delaware, Maryland, and Pennsylvania, it is required to have products available free of charge in schools. How is that going?
Dr. Robyn Miller, Nemours Children’s Health:
That has been an initiative that’s happened over the last few years, and it was wonderful. When I first started talking about this with patients, I think it was 2022, and a lot of patients would say, “Yes, we have period products in the bathroom. It’s wonderful.” But it changed. They stopped having it because I think what a patient said that kids were being kids and playing with the products or doing something other than using it for their menses. And the school’s answer, from what I’ve heard from patients, I’ve never spoken to anyone in the school system, is to just remove the product so they didn’t have other issues from having those around. And so it worked and they were very grateful for it when it was there, but they’re not as reliable anymore.
Carol Vassar, podcast host/producer:
Do you have a firsthand patient story, not going too deep into because of privacy issues who they are, where this period pantry has really benefited them?
Dr. Robyn Miller, Nemours Children’s Health:
So there is a patient where, because our period pantry started in June or July of 2023, and so we have started to screen for the need of period products because we have limited supply so we make sure we give them to the people who need it the most. And I did have one patient whose mom and herself were very grateful for products and the fact that they existed and was the first patient to ask, “Can I come back next month for these?” And I hadn’t really thought that far in advance, but my answer of course is yes. And so we’ll figure it out. And so that family, we did a 5K in September to raise products for the pantry, and I had a raffle along with it, and one of the raffles was a menstrual basket that has all the different products, pads, tampons, panties, cups, things like that.
And one of our staff, one of our resident physicians won the basket and they donated it. And so that family is going to get the basket with all the different products for them. And so I think that that’ll help. And there’s some reusable products there. Now, not everybody’s going to want to use a menstrual cup or want to use menstrual panties, but the idea is that we take at least the price of things away so you can try it and if it works out well, great. If not, then it’s your choice to use something else, but at least we’ll give you these products so you can try it. And so cost isn’t prohibitive. So we’re excited about that.
Carol Vassar, podcast host/producer:
What’s your advice to parents who might be listening, policymakers who might be listening about A, getting rid of the stigma and B, making sure this product is available to every woman who needs it, especially the teens that we serve?
Dr. Robyn Miller, Nemours Children’s Health:
Yep. So I think discussions and taking the stigma away, I think still as adult women when you’re going to the bathroom to change things, we still hide our products and make sure it’s in a very discreet manner when it really doesn’t need to be. And so I think taking a moment and really just living life and not hiding it, I’m not asking people to shout it from the rooftop that they’re going to the bathroom, but not taking that extra step to be super discreet about it. It’s a natural process, nothing to be ashamed of. It’s supposed to happen.
And so policymakers, there’s still definitely certain states that still have what we call a pink tax where they tax certain products as a luxury item and a lot of feminine hygiene products, including pads and tampons, razor blades, things like that, have this luxury pink tax associated with it. Delaware doesn’t have sales tax, so we didn’t have to fight that hurdle. But the surrounding states like Maryland, Pennsylvania, and New Jersey, they’ve gotten rid of it. More states have removed that tax than not, but there’s still some that still have the tax there. And so, there’s still work to be done in that realm. I think it would be great. There really aren’t products available in schools or just stores if you’re out somewhere if you get caught. You can always, oftentimes I think people can ask people in stalls for help, but it would be nice if it was just available in the public for people to use as well.
What I would love to share is that if people would like to support our period pantry here at Nemours, we do have an Amazon wish list that has products available listed that we need, and that is an updated list. It’ll change based on donations that we’ve received or the need that patients have. And so again, we just started, and so we’re getting an idea of what patients truly request, if it’s more pads, if it’s more tampons to be able to fluctuate, if they’re open to menstrual cups, those types of things. And so that list is a living list and reflects the true need of what’s needed at the time, but it allows people to donate virtually wherever they are. It can be a one-time donation, it could be every few months type of donation. It’s a great way to be able to do it if you’re not able to be here at the hospital.
Carol Vassar, podcast host/producer:
Excellent. Dr. Robyn Miller, thank you so much.
Dr. Robyn Miller, Nemours Children’s Health:
Thank you.
Carol Vassar, podcast host/producer:
Dr. Robyn Miller is an Adolescent Medicine Specialist at Nemours Children’s Health Delaware. The link for the Nemours period pantry Amazon list can be found in the show notes for this episode.
MUSIC
Carol Vassar, podcast host/producer:
Partnering with outside organizations is a key way in which Nemours works to positively influence the health outcomes of children when they’re not within our walls. One of those organizations is Duffy’s Hope. Since 1998, Duffy’s Hope has been serving at-risk teens in Wilmington, Delaware, by providing them with one-on-one mentoring, tutoring, financial literacy, educational and enrichment trips, etiquette training, school and home visits, inspirational guest speakers, and group discussions.
And there’s basketball too, as one of the core beliefs of Duffy’s Hope is that involvement in organized team sports provides meaningful, healthy, and safe activities for youth, fostering team building and providing opportunities for positive social behaviors. Duffy’s Hope is the brainchild of former Harlem Globetrotter Allen “Duffy” Samuels. And our podcast team member Che Parker caught up with him recently to learn more about the grassroots community work done by this nonprofit with a little help and hope from Nemours.
Allen “Duffy” Samuels, Founder, Duffy’s Hope:
Duffy’s Hope is a nonprofit organization based in Wilmington. We started out working with just City of Youth, the youth in Wilmington, but now we’re statewide, so we work with ages 13 to 17 boys and girls. So, we do prevention and mentoring programs. So the main thing is we focus on education, life skills, decision-making, job readiness, college readiness, prevention of drugs, alcohol, gangs, and financial literacy.
Che Parker, Nemours Children’s Health:
Is there any particular program that you’re really proud of the work that’s being done?
Allen “Duffy” Samuels, Founder, Duffy’s Hope:
I would say all of them. We have the ambassador program, which goes from September to July. We get the month of August off. We have the evidence-based curriculum that they go through all year long, and a lot of our kids are graduating, so our retention rate is 85%. So I always tell the parents and the students once they come for an intake, whatever you put in is what you’re going to get out of it. So if you only put 10% in, you only get 10% out. But a lot of our kids put 100%. So they come in and they change their lives from things they… Not going to school, to going to school, to being a part of the crime in the city, and now they’re not part of the crime. So it’s a good thing.
But going back to the question, I would say all my programs, because I look at my basketball league as well too. We work with 125 young men from June to August, and these young men want to be a part of the game. not only did they play basketball, but they had to attend a 45-minute workshop before they played. If they don’t attend the workshop, they cannot play that day. The workshops contain self-awareness and conflict resolution. We have speakers from Job Corps. We have colleges and universities come in. We also talk about healthy eating and healthy living. So we have a lot of topics that really benefit these young people. And at first dealing with young basketball stars, they want to be like, “Oh no, I don’t want to do that. I’m too big for that.” But once they get engaged, they go to the workshop, it’s mandatory, they start getting engaged. So now they look for the workshop the following week.
So that’s one of the big things. So I’m proud of that because a lot of these students, once they leave us in August, they carry on that same mentality or what they learned from us in the summer into school. So when we see them during the school, we go do school visits during the year, they go, “Oh, Mr. Duffy. I almost had an issue with another student, but I remember the conflict resolution that you told us. Breathe, reflect, think about your actions before, don’t react. Think about them.” So I would say that for me, I’m happy that we and my coaches, because they all volunteers, that they came and instilled this stuff in our young people. So the basketball league and the basketball programs, I’m proud of both. So, I can’t say one or the other, but they both worked differently. So…
Che Parker, Nemours Children’s Health:
How did you get into this work?
Allen “Duffy” Samuels, Founder, Duffy’s Hope:
I got into it some years ago because, growing up, a lot of people gave me an opportunity for my community. I was a knucklehead. Didn’t think about anything, and so a guy named Judge Farnham came into our community and provided a basketball league and then also life skills to us. And then from there, I was like, “Wow, I like this.” So it gave me an opportunity to use the orange basketball as a tool to get out of my neighborhood and not just be a basketball player, but it made me become a student-athlete. And so I always said, my mama said to me, “Once you leave here, make sure you always come back and help somebody else out.” So that’s how I got into Duffy’s Hope.
Che Parker, Nemours Children’s Health:
So, of all the kids’ lives you’ve impacted over the years, are there any particular stories or kids that stand out in your mind? Someone or a situation that you’re really proud of?
Allen “Duffy” Samuels, Founder, Duffy’s Hope:
Well, it’s several. I know one is on her website: a young lady named Diamond. She came to us at 12 years old. She was heavily involved in the streets. She was actually prostituting at the age of 12, and the courts asked me because she was into basketball because, at that time, we had a girls’ basketball league and could do something to try to save this young lady. And she was hard to reach at first. Then, finally, she came around and said she really wanted help, so we helped her.
So this young lady went from not going to school. She had missed 85 days of school. So the following year to going to school, only missing maybe 15, and then going to Brandywine High School and becoming a top in her class. She graduated with a cumulative of 3.89. She had a 2010 on her SATs. So we got her a full ride to school. She actually got her bachelor’s of science from University of Delaware in Political Science, and then she got her master’s from Wilmington University. So our next step is she wants to go to law school because she always wanted to be a lawyer, so that’s where she’s hinting to. So she wants to go to law school, she wanted to take a year off so right now she’s motivated. And so this young lady’s actually on our board now. So that’s the success story.
Che Parker, Nemours Children’s Health:
Allen “Duffy” Samuels is the founder of Duffy’s Hope, based in Wilmington Delaware.
MUSIC:
Well Beyond Medicine!
Carol Vassar, podcast host/producer
Thanks to Dr. Robyn Miller and Duffy Samuels for joining us on this episode of the Nemours Well Beyond Medicine podcast. And thank you for listening. Remember, our podcast home is nemourswellbeyond.org. There, you can also find all of our past, present, and upcoming podcast episodes. You can also subscribe to the podcast and leave a review. Our production team this week includes Che Parker, Susan Masucci, and Cheryl Munn. Join us next time as we explore an innovative way to address the shortage of healthcare workers by training high school students for careers in healthcare. I’m Carol Vassar, and until next time, remember, we can change children’s health for good, well beyond medicine.
MUSIC:
Let’s go, oh, oh. Well Beyond Medicine.
