How Do We Improve Awareness About Menstruation and Period Poverty?

Menstruation or “periods” is a basic fact of human life – and yet, there still exists a deep stigma and shame around this natural cycle. This contributes to a phenomenon known as period poverty, defined as a lack of access to menstrual products and hygiene facilities. Globally, an estimated 500 million people experience period poverty, and in the United States, 1 in 5 teens have struggled to afford period products or have not been able to purchase them at all. Furthermore, period poverty disproportionately affects Black, Latina, immigrant and first-generation students at higher rates than others.

Researchers like Allison R. Casola, PhD, are aiming to understand the complex factors that hinder open communication about the needs of menstruating individuals, and how to improve access to products and resources for menstrual wellness. Read more about Dr. Casola’s work and how her research journey evolved to focus on this topic.

Q: How would you describe your research to the person riding the elevator with you?

A: My research focuses on menstrual equity, the notion that people who menstruate should be able to freely manage their cycle safely and with dignity. There are a lot of attributes that surround menstrual equity: communication norms and attitudes towards menstrual health and wellness, as well as advocacy and awareness about period poverty, which is the inability to access sufficient resources to manage one’s period, and its associated impacts.

Having limited quantity of products may lead to longer-than-recommended use and contribute to skin chafing or vaginal toxin overgrowth, which can be dangerous or even deadly. It is also just stressful and can be mentally draining for a menstruator! They may be concerned that they have a leak on their clothes, can only wear certain things and/or may not feel comfortable going to school or work because they don’t have products.

Overall, there is a significant lack of focus on menstrual health in society, science, research and medicine, which is largely attributed to deep-seated stigma, shame and discrimination and contributes to period poverty and menstrual inequity. I just really want to normalize menstruation – because it is a normal bodily process.

Q: What problem does your research try to solve? What’s one question you’re exploring currently?

A: More specifically my research strives to understand communication patterns around menstruation. Overall, we simply do not talk about menstruation enough to bring attention to period poverty concerns. So there are a lot of questions here that I am currently studying. Why is menstruation a difficult topic to discuss? Why does talking about having your period always seem to be hush-hush? How does the nature of the conversation change when talking to peers? Or family members? Or a healthcare provider? Do healthcare providers understand how to talk about the nuances of menstrual health – beyond asking when the last date of a patient’s period was?  How can a provider address period poverty with a patient? These are all questions I am trying to understand, and ultimately use as evidence for how to promote menstrual health awareness in order to combat and dismantle stigma.

Q: What first sparked your interest in your area of research/your research question?

A: In general, I’ve always been interested in women’s health. During my undergraduate studies, I was really intrigued by developmental biology and immunology – specifically how the placenta transfers nutrients from mother to fetus during pregnancy. As much as I loved biology, I knew I didn’t want to work under a microscope for the rest of my career. I then found public health, which for me was the perfect blend of science, action and advocacy and community engagement. As I started my Masters in Public Health, I learned a lot about health behavior theory and community wellness that I started to apply to my interests in women’s and reproductive health. I continued to apply these constructs in my doctoral work on contraceptive use behaviors and unintended pregnancy prevention among adolescents and young adults.

My interest in menstrual health and period poverty really sparked from reading a Philadelphia news article on the train one day in July 2019. I had just started my post-doctoral fellowship here at Jefferson, and was in somewhat of a “research rut.” I felt like my work examining contraceptive-use behaviors and sexual risk among young adults had run its course and I was searching for ways to connect my interest in reproductive health and women’s health to primary care and family medicine. Thinking more broadly about reproduction and focusing on the menstrual cycle and uterine health brought back a lot of joy into my scientific inquiry.

Overall, I consider myself a social-reproductive epidemiologist, meaning that I focus on the psychosocial aspects surrounding reproductive health decision making and women’s health.

Q: What is the best memory you have from conducting your research and/or teaching?

A: One of my best research memories was meeting and connecting with my now community research partners, at Community Driven Research Day in December 2019. This is a networking style event for academic researchers and community leaders to meet and connect, with the opportunity to submit a grant proposal to conduct a collaborative research project. I immediately connected with Lynette Medley and Nya McGlone of No More Secrets, a uterine health organization that developed the only feminine hygiene bank in Philadelphia – and coincidently the focal point of the news article I read in July 2019 that sparked my interest in exploring menstrual health. We ultimately submitted a proposal to explore menstrual communication and were funded. Flash forward four years later, we are still collaborators and supporters of each other in the menstrual health space.

Q: What’s a unique fact, surprising statistic, or a myth about your study subject?

A: That 1 in 5 menstruators will experience period poverty. It’s a lot more prevalent than we might think, and even more so that it is broader than just having enough menstrual products. Yes, having period products is critical, but it also encompasses having private and accessible bathrooms, soap and clean water to wash one’s body, means of appropriately disposing used products and knowledge about menstruation and menstrual management.  All of these aspects are crucial for an individual to manage their period safely and with dignity.

Q: What’s something you’re passionate about outside of your research?

A: I love to exercise. Yoga, weight lifting, cycling, hiking, cross-training, walking. I work out a lot at home, but you can regularly find me on the trail or trying out a new group fitness class.

Q: Who’s a role model or someone who shaped your journey? Is there a piece of advice that stuck with you or that you try to pass on to young researchers?

A: There are many people who have shaped my research journey. My PhD mentors, Drs. Deborah Nelson and Resa M. Jones at Temple University taught me so much about research methodology and approach. My post-doc mentors (and now colleagues) here in the Department of Family and Community Medicine, Drs. Randa Sifri and Amy Cunningham encouraged me to explore the area of menstrual health; and my incredible community research partners, Lynette Medley and Nya McGlone of No More Secrets, have been indispensable collaborators, ensuring that my research reflects the needs and voices of menstruators in our community.

I teach and mentor a number of students and trainees in Sidney Kimmel Medical College and the Jefferson College of Population Health, and my advice to all of them is to learn from anyone willing to teach you. Learn fundamental methodology and foundational research techniques that you can use to build your skillset. You’ll be able to take those skills with you everywhere and can ultimately apply it to your specific topical area.