Interview with Public Health Pioneer Marni Sommer

LONDON/NEW YORK VIA SKYPE: When Marni Sommer, an associate professor of sociomedical science at New York’s Columbia University’s Mailman School of Public Health, was working on her doctorate in public health 12 years ago she quickly realized her research topic could often abruptly end conversations at dinner parties. “People would say, ‘Oh, what’s your dissertation on,’” she reminisced during a recent Skype interview. “And I would say, ‘I am working on menstruation’ and it would be, ‘okay, pass the potatoes.’” But Dr. Sommer added that the taboo nature of the topic was one of the reasons why she started her research, which looked at girls’ experience of menstruation, puberty and schooling in Tanzania and how the onset of puberty was possibly linked to disrupting their academic performance.

Fortunately, times have changed thanks to more attention being paid globally to those subjects both in the media and by governments, the development community, and those in the health and hygiene sectors. “Now it’s fascinating because it is constantly in the news in the U.S.,” she said. “So the number of dinner parties I go to, and I now tend to talk about my other work, but when I do mention it people will say, ‘Oh yeah, you know girls drop out of school because of lack of access to sanitary napkins.’ Actually, I don’t know that we know that but it is fascinating to me that people are telling that back to me when 12 years ago it was, ‘Is this an issue? Why are you looking at that?’”

Ms. Sommer’s research projects have included the “Girls and Boys Puberty Book Project”— started in Tanzania in 2006 and later published in Ghana, Cambodia, Madagascar and Ethiopia with new books underway for Pakistan—which provides basic guidance for adolescent girls on body changes and menstruation, and for boys to help them understand peer pressure and puberty. Ms. Sommer is currently also working with the International Rescue Committee on a Menstrual Hygiene Management in Emergencies Toolkit, which helps respond to menstrual hygiene management (MHM) for displaced or refugee girls and women in emergency contexts, such as those after a disaster or conflict. She spoke with Ginanne Brownell Mitic about her fascinating—and important—research across the globe. EXCERPTS:

BROWNELL MITIC: How did you get interested in looking at girls’ education and menstruation?
SOMMER: I was a Peace Corps volunteer in Eritrea in the 1990s and was a teacher in a rural village school. We were all told to focus on girls because girls drop out more than boys and there were all these gender dynamics. And the understanding was that it was because of puberty, and that they dropped out to get married. There were no toilets in the school and I remember thinking “how do they manage their periods?” They sit all squished in the desks, and some walk an hour to get here and there is certainly nowhere to go along the way. When I ended up doing my doctoral program what I wanted to research was girls’ education-related issues because even though I was in public health, I continued to go back and forth between the two.

The barriers that girls face to their education across the globe has become a focus of a lot of research lately, but I assume when you started in 2004 you were one of the pioneers at least in terms of issues related to schooling and menstruation?
I really got into the issue: why do we still have this gender gap? It became clear to me that we actually know a lot about the numerous reasons for this gender gap but during my studies I would see a lot of references to girls dropping out because of puberty, with these references to toilets being important. But there was no research as to why. So UNFPA [United Nations Population Fund] would have this statement, “they need toilets” but then

you would try and track the footnote, it would be a 1920s male anthropologist. So I thought, “Seriously, is that the data we are working with?”My reading of the literature up until then –and it still happens now–had been that in public health you have limited resources, so you focus on who is dying and who is sick. Because of the focus on older girls with higher rates of morbidity and mortality this earlier age group of younger girls were not getting this information. There were a lot of assumptions including, ‘Oh aren’t they learning about that” or “aren’t parents telling them?” So it was eye-opening.


Do you feel like there is more of a conversation now on these issues?

In some respects, there has been a sea change in the 12 years since I have been working on this. So I think there have been so many charismatic people out there looking at that and there is Menstrual Hygiene Day. But if you go to rural Ethiopia, are they going to want to talk about it? Probably not. And is that going to be comfortable in Pakistan? Again, probably not. So we have a long way to go.

There is something of a debate among those who work in education, development and hygiene sectors about whether girls miss a lot of school because they are on their periods. How do you weigh in on this?
It’s not just about products [like sanitary pads] but people want a magic bullet to solve this. And talking about toilets is not sexy. So I think the products get more attention—but other things should be getting attention: information, physical infrastructure [in schools], not just a toilet but a clean one that is safe with a lock, a place for disposal and clean water. In terms of the experiences of menstruating, some girls are fine, they are not missing anything but I think some will leave school, go change and come back because they do not have decent toilets. Some girls leave in the middle of the day, they get their periods and they do not have anything to manage. Some girls struggle to stand up in class because they are afraid they will have a stain in the back or they may go to the back of the class. But then they may get punished because you should be standing up, you should be active.

There have been a number of entrepreneurs out there trying to make cheaper, more cost effective sanitary napkins, some of which are even reusable.
I talked to Proctor and Gamble and I remember one of them saying to me, “We would love to make a cheaper pad, we could make a cheaper pad but it would not last eight hours and what I have seen from schools, girls need this pad to last eight hours because there are not toilets.” So it is great to have cheaper pads, great if they are more affordable but again that should not take away the need for the other components, which I think are critical.

Tell me about your toolkit that you are working on for emergency and conflict situations.
There are culturally sensitive issues around menstruation like having a disposal or incinerator in refugee camps. Some will say, “fine,” while some worry about pollutants or in other places the girls and woman will say, “If you burn the pad, something bad will happen to me or my fertility.” In Myanmar they buried [pads] in IDP [Internally Displaced Persons] camps, even though they had a disposal. So they were getting up 5am and burying the used materials. And it’s a limited plot of land. And other places, burying would not be what they want to do. So it’s hugely cultural.

by Ginanne Brownell Mitic

Photo courtesy: 1)Girl in Kenya,  WaterAid/Behailu Shiferaw;  2) Headshot of Marni Sommer, Columbia University; 3)  Girl in front of toilets, Madagascar, WaterAid/ Anna Kari,; 4) Rewashable pad, Kenya, WaterAid/Behailu Shiferaw, 



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