In this encore presentation of Well Beyond Medicine, we explore the timely topic of period equity with Nemours Children’s Health adolescent medicine specialist Robyn Miller, MD.
Menstruation is 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 people due to financial concerns or lack of communication and openness on the topic due to stigma, or cultural and religious considerations.
Nemours Children’s Period Pantry Amazon Wish List
Guest:
Robyn Miller, MD, Interim Division Chief of Adolescent Medicine and Pediatric Gynecology, Nemours Children’s Hospital, Delaware
Producer, Host: Carol Vassar
EPISODE 94 TRANSCRIPT
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast, produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week, we’re joined by innovators and experts from around the world exploring 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. Well Beyond Medicine.
Kotex Audio Clip:
There’s nothing strange or 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 is 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. In this encore presentation, Dr. Miller joins us to discuss period equity, what it is, how we can talk more openly about it, and strategies to ensure that no person needing product ever goes without.
Dr. Robyn Miller, Nemours Children’s Health:
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 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. I’ll take a step back. In adolescent medicine here at Nemours, what we do is a lot of menstrual management. All day, every day I see girls that have prolonged periods, short periods, absent periods, painful periods, everything you can think of.
What I’ll see is that some family members, it’ll be three generations of women in a 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? 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 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 it’s 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.
They 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, it’s 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:
Learning that your period is not going to be your best friend’s or 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 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, like 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? 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:
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 nine or ten years old. And so I’ve had patients that started their period, they didn’t know what was happening. They’re just bleeding from their 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. I’ve had patients who thought that they’ve gotten their period, and like, 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 or 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 her 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 education within the family depending on cultural background and religious background? Talk about that.
Dr. Robyn Miller, Nemours Children’s Health:
Absolutely. 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’s 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’s 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 for 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. 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 one, two, three, four, five. You have ultra thins. You have maxis. It’s kind of 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 of tampons around eight 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 a 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, kind of anything goes. And so you could 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 interest 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. 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, so 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 first-hand 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… 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 supplies, 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, the fact that they existed. And it 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’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:
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 pimp 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 to 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:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
Thanks to Dr. Miller for joining us to talk about period equity, and thank you for listening. Remember, our podcast home is nemourswellbeyond.org. There, you can find all of our past, present, and upcoming podcast episodes, and you can also go there to subscribe to the podcast and leave a review. That’s nemourswellbeyond.org. Our production team for this encore episode includes Che Parker, Susan Masucci, and Cheryl Munn. I’m Carol Vassar, and until next time, remember, we can change children’s health for good well beyond medicine.
Music:
Let’s go. Well Beyond Medicine.
