Spotlight on Child & Adolescent Health: Period poverty

Georgia Bisbas and Priya Chudasama are joined by Jhumka Gupta, Zeal Desai, and Ziyu Peng to discuss "Taxes, Taboos, Tampons, (and TikTok)—the state of period poverty worldwide".

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Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Georgia: Hello, and welcome to The Lancet Voice. It's March 2023. I'm Georgia Bisbas, and I'm here with my co host, Priya Chudasama. Today we're publishing the third in a series of podcasts spotlighting issues in child and adolescent health. You'll be able to hear the two previous episodes in the series on the topics of peer support and indigenous communities wherever you're listening to this podcast.

Today we're going to be talking about the topic period poverty. First, perhaps we should introduce ourselves. 

Priya: Hi everyone, my name is Priyotri Nisarma and I work as a senior assistant editor at The Lancet. My background is in biochemistry as well as higher education for medical examinations and FTM publishing.

Georgia: And I'm Georgia, an editorial assistant here at The Lancet. My background is in humanities and literature but I've also got previous experience volunteering for period poverty charity and we're going to be talking to three guests about period poverty. Coming up next.

Priya: So today we'll be discussing the topic of period poverty, and we're joined by three guests who have experience and expertise in this area. It's a really important topic that's increasing in public awareness, especially in women's rights. So we're keen to delve into the effects and risks of period poverty, as well as looking at accessibility, sustainability, and looking into the future.

So Georgia and I would like to welcome you all to our podcast on taxing taboos, tampons, and TikTok. date of period poverty worldwide in 2023, and to welcome our esteemed panel who we have with us today, who will ask to introduce themselves in just one moment. So we have Professor Jumka Gupta from the George Mason University College of Public Health, Deo Desai, who is the founder of an organization called Pre Imperiots, and Tzu Yu Peng, who is a member of the Lancet Child and Adolescent Health Youth Advisory Panel.

So welcome everyone. So let's get started let's start with Professor Gupta. Would you like to tell us more about yourself? 

Jhumka: First of all, thank you so much for having me. It's an honor to be on this panel and this topic. I am a mixed methods researcher and I focus on violence against women and health and menstrual justice as well.

Ziyu: Hey, great. And then over to zeal. Yeah, I just moved to London from China five months ago, and now I'm currently a master's student on learning social media and digital communication. Yeah, thank you for having me here today. Great. And then to zeal design as 

Priya: well. 

Zeal: Hi, everyone. I'm zeal co founder of green periods.

We are a registered nonprofit that does work pretty much all over the world through online and outreach that are also in person. And we are an initiative on sustainable menstruation mostly focusing on reusable menstrual products and education surrounding that. And through that, we are tackling the economic, ecological, and health impacts of menstruation for the people, planet, and the wallets of the people.

You can check out educational tools on our website for more information at dreamperiods. org. Thank you for having me. So, yeah, 

Georgia: if I could just start with a little bit of background on this topic for those who might not be as familiar so Zeal, maybe if I could start with you what is period poverty and how do you think this problem has kind of arisen?

Zeal: Yeah, thanks for that question. I think it's the need for the hour because a lot of us don't realize or really know what this term means. So, as it sounds, this is when people who menstruate. Are unable to afford menstrual products or even adequate resources for menstruation, like hygiene facilities, education, waste management, or even a combination of all of these, it affects about 500 million people worldwide.

And it keeps a lot of people from going to schools or carrying out their day to day activities with dignity. 

Georgia: The 

Zeal: dignity 

Georgia: and the kind of prohibition of, of day to day activities is something we're definitely going to pick up on a little bit later as well. So thank you for introducing it. 

Priya: What are the main causes of period poverty?

So let's go to Professor Gupta with that one. 

Jhumka: Yeah, I would say that the causes are numerous, I think. I think one of the biggest causes from my perspective is really the deep prioritization of this topic from policymakers to anyone in a decision making power. It's a very. Stigmatized topic, a very de prioritized topic when it comes to policymaking to ensure products are available.

So, to me, that's 1 of the biggest drivers as well as societal stigma around discussion of period poverty, but menstruation in general. That's 

Georgia: interesting. Thank you. So you said the societal kind of stigma about it. So do you think there's maybe a lack of knowledge around it? And what would you say is one misconception about period poverty that you think everybody should know or you are trying to actively debunk?

Jhumka: One main conception, and I think Zeal did an excellent job at addressing that, is when people hear the term period poverty, The often go to thought is that it has solely to do with products and making products available. And that's really important. But the other components are having adequate facilities, access to running water, access to a private area for changing products and access to information.

So I think all of those are really important. 

Priya: Let's now move on to the effects on women and the risks and taboos. How does period poverty affect women? So let's start by talking about geographically worldwide. So let's go over to Jingyi for that. 

Ziyu: Yeah, actually, before this recording this podcast, sorry, sharing this, according to a World Bank statistic, like about 500 million women around the world lack adequate natural hygiene facilities.

And especially in China and you are just like, Oh, you went to, you go to Starbucks, then like 4 pounds, 5 pounds for a drink. You cannot afford like pads, but that's actually didn't realize that like actually 600 million people in China monthly income is like around less than 1000 RMB, which equals to like around 120 pounds.

Monthly, so if it's like one RMB, it's like cheapest pass, like one RMB for one pair, right? So from the, when you're 12 years old, your first time, get your parents and to like maybe 50 years old, you stop getting periods. That's a lot of money. And for those, for those 600 million people in China, mostly encounters like.

120 pounds, they cannot afford it. So that's why, like, so many people online is like, Oh, just like a few pounds, you cannot afford it. I think that's something I misunderstood. I mentioned you're going to Zeal. 

Priya: And so how would you say it affects women, girls and young people while they menstruate geographically?

So let's say maybe in the USA, how would you say? 

Zeal: Yeah. So a lot of people don't associate period poverty with the so called developed countries like the U. S. or the geographical West. However there have been studies that have found that almost two thirds of women in just one major U. S. city with a low income could not afford menstrual products in the last year.

That was 2021. And A lot of them, about half of them, had to sometimes choose between buying food or menstrual products. So, this is a very big problem, not just in the developing parts of the world. However we can see that this affects people of all geographical areas. And Even people obviously in the global south are the ones that are most to suffer.

If you look at, you know, African countries, obviously, or you have some Asian countries where there are a lot of taboos, a lot of stigma that exacerbates this problem of period poverty. And then of course, when you take into account the economic factors. It just makes it almost impossible for people with who menstruate to do so in in a dignified way.

Yeah, 

Priya: yeah, completely agree. Also so I'm from an Indian community as well, so for us, in terms of taboos, we something where people think that we are unclean, so we can't go to certain temples and ceremonies, and this is something I've experienced myself as well, and it's not very nice. Is there a way that taboos such as this one can be overcome in the future, and what would you say are the steps 

Zeal: that we would need to take?

Certainly, I think there's always a way to overcome any socio political cultural challenges. And I think we are on our way towards mitigating period inequity in the world. And I'll give you an example of India, which is also my home country. And I've seen in my last almost three years of work in this field that The most number of innovative menstrual equity reforms are coming out of India surprisingly.

And this is not just about having access to people of different backgrounds, but we're looking at a lot of initiatives coming out of the rural areas as well. And it's typically on sustainable menstruation. Now this is unheard of in a lot of other parts of the world. While the rest of the world is fighting to give free disposable tampons or pads to the people who can need and use them, India is fighting to give out free menstrual cups or even reusable pads.

to their citizens. So I was just in Kerala. It's a South Indian state. And yeah, it was, I was there about two days ago. It was surprising. I was just amazed to interview some people out there because the government as well as a lot of NGOs on the ground, along with a DIM, Indian Medical Association doctors.

They have tied up together in a very groundbreaking initiative where they even broke a Guinness World Record for distributing 100, 000 menstrual cups to that area, in that area of Caroline, just a couple of counties around there, actually, in Kumbalangi. And it was just amazing to talk to some of the people who were beneficiaries, as well as.

The person, the doctor, who headed that initiative from the IMA. So I, I just feel that there is, we are making progress. These are just baby steps. Of course, we can't miss out Scotland, who just mandate free men, free menstrual products for all of their citizens. Yeah. Just back in 2018 or 19. And, you know, you have other initiatives more on the grassroots level, right?

And the rural communities where a lot of your, little cottage industries around reusable menstrual pads or even cups are popping up as social impact initiatives. So there's just a lot of groundbreaking work being, being done, but a lot of it, unfortunately, doesn't receive the kind of importance and the kind of limelight that it should get because it is just such a misconceptualized and taboo topic.

Priya: Yeah, exactly. We agree. Yeah. I see. Would you have anything to add to that? 

Ziyu: Yeah, so Miro was just talking about a rural area in India, so actually, like, China has kind of similar situation because, like, some areas, some provinces in China is not that well developed, like the rural area in China, so I used to interview one of the founders of an NGO.

So, when they go on, went on a trip to the Guizhou, which is the rural province in China. They find that the women that live in the foreign house at the time and they often handle washed clothes in the yard, but you can only see men's and children's clothes. Not the woman's clothes, and then they asked, like, why is that, like, and then they realized that because the woman's clothes were hanging on a very concealed steel wire outside the house, where the sunlight was not, so they, they did a physical, they organized a physical examination in the local women's literacy class and find that many women there had, had gynecological disease, diseases.

So some even very serious. So, like, people think that it was normal for married women to, to have these kind of diseases. But I think that the prevalence of this kind of disease is maybe related to 

Georgia: the drying of women's clothes. That's so interesting. I think we'll, we'll definitely come back to the kind of the risk of like the health side that's often overlooked as a result of the measures that some people have to take.

So you mentioned at the very beginning that you've only been living in London for a few months now. Yeah. Have you noticed kind of a big difference between access and, you know, do you and your peers talk about it in a different way? Like are people more likely to kind of bring it up and engage with the problem?

here as opposed to in China? 

Ziyu: First of all, like under this kind of economy in the UK, like the cost of living is like rising crazily. 

Priya: Yeah. And, 

Ziyu: and, but one of the things I found here in the UK China is that In Scotland sensory products are free because I went to St. Andrews the other day to visit my friends and she's like, she told me like, Oh, all the pads in here are free, like when I would go to the bathroom, toilets of the university or just like public bathroom, there are pads you can choose for free.

So I think that's the biggest difference between China and Europe from my experience. 

Priya: And then just talking about cost of living I have a question for Azil actually, so in terms of just money, how much money would be potentially saved if they were to use sustainable products? 

Zeal: Yeah, that's a great question.

And it's it's formed the basis for green periods and the reason why there isn't an outro for green periods why we exist. So basically I decided to one day I've been using. A reusable menstrual cup for the last 10 years, the exact same cup that I'm still using today. And it just dawned on me on World Menstrual Hygiene Day during the pandemic when we all had time to just sit around and think of things that we never really thought about what the impact in terms of waste and cost for period products would have been at least in my case, and I started doing the math and quickly I realized this was something that most other people should be thinking about and that's how the Menstrual Footprint Calculator was born.

So what that does is for different individual people, they can put in their own patterns of usage for menstrual products, and they get to see exactly how much money they're spending on menstrual products over their lifetime and until now. So from the data that we've gathered so far, you know, of the last two, three years that we've been doing this, we have found out that on average, a menstruator is spending anywhere between three and 5, 000 on menstrual products in US, in USD.

And this is just on disposable products. So we kind of tried to. Segregate the different product types because that's important that it we're trying to drive the point across that recurring costs versus one time costs. You know, that is a big factor in, in the savings, both in terms of waste and cost.

Because a reusable product tends to last much longer and. I, you don't have to keep buying. The products over and over and over again every single month. We have seen that reusable products are only costing a menstruator about 200. Give or take and a hypothetical utopian scenario where somebody were to start using a cup today on their first period until the time that they had to keep buying the cups over 40 years of their menstrual life cycle or lifetime.

So we're looking at huge despair disparities here in terms of the cost, right? For people who try to only religiously use reusable products, if that's something that they're into. They're spending about 10 times less money. And again, waste is a whole another topic that we can, you know, have another podcast.

Priya: So just talking about the risks a bit more, what risks are associated with the effects of period 

Jhumka: poverty? We talked a little bit earlier about About menstruators leaving products in for longer than they should simply because they can't afford more. So that's a risk as well as substituting products with rags or towels or things that are just not clean and what can happen from that is essentially infections within the urinary and reproductive tract.

Also skin rashes and irritation, but also I think even broader than that there's there's a large mental health toll from period poverty. We just did a study that came out in 2021 with college attending students in the United States. And what we found is that for those who reported experiencing period poverty in the past year, there were 1.

8 times more likely to report symptoms consistent with depression than their counterparts who did not report period poverty. And if the participants reported experiencing period poverty on a monthly basis, there were 2. 3 times more likely to report depressive symptoms. And That's a really important issue because mental health is a critical issue for college students, especially now the question is why and I mean, there could be a variety of reasons.

It's just, you know, the constant stressor of having to think about products and. Deciding whether to put money towards food or products being worried about stigma, being worried about attending class or keeping a job. So it does take a mental toll. 

Priya: And then in terms of sexual and gender based violence as well is that something that comes about and how, how does that happen as well?

Jhumka: Yeah, that's a really interesting question. I kind of come to the menstrual justice research space from a violence against women lens. And I think before I get into some of the specifics, I would say some of the commonalities between GBV and period poverty, as we've been talking about is deep seated societal stigma gender norms, the tendency to blame the victim per se, I think, yeah.

Z, you was talking about some of her observations where people at the workplace blame the woman for not bringing products. If she knew she had it, you see the similar type of victim blaming with violence against women. And then just the deep prioritization of these issues, but I mean more specifically you know, if you know if wash facilities are not available.

Women and other menstruators may have to travel farther, which can increase vulnerability to sexual violence, especially from nonpartners. If these facilities are farther away, or they're not well lit. In humanitarian crisis settings, wash facilities might be controlled by. Others, and there might be instances of survival sex to use those facilities.

Within the private home I'm specifically talking about intimate partner violence I think that's been less researched, but there's been some work that has documented conflict. And violence if women have to travel to get water, because that might take away time and efforts that she has available for other household responsibilities so that can also create conflict as well.

Priya: Yeah, it sounds like there's so many actually I didn't really think there would be so many but that's really interesting. And then just to just talk about further about your paper that was published, so have you seen any improvements or changes to campus life in terms of provisions and mental health support since the paper was published?

Jhumka: Yeah, I mean, I think first I want to say that I think a lot of college campuses have been working on this issue in pocket. So, you know. It's only through this paper and connecting with a lot of universities. I've been able to really learn what a lot of campuses are doing and there's a lot of great efforts happening at the local level.

I think that the mental health piece has been really important for advocacy, especially in this COVID era, as mental health has become a very important issue for university students. It's been another tool in the toolbox that advocates can deploy. California, since this paper came out I know that They were able to cite this paper in their advocacy efforts with university.

And state level representatives about another importance of making products available. So. There is definitely meant, and this paper is an important part of it. That's interesting. Thank you. If 

Georgia: I, 

Could just go back a moment, Professor Gupta, you mentioned about the kind of increased risk of gender based violence and the coronation of period poverty and humanitarian crisis, but I think it's also, you know, it's, it's so hard not to think at the moment about the kind of devastating effects of the earthquakes in Turkey and Syria.

How much do you think there's a really kind of urgent risk when it's in a war zone or a kind of when, you know, there's lack of sanitation and the danger and hygiene and running water, all these things we've mentioned. Do you think people often overlook the really urgent risk of hygiene issues when it comes to disaster zones as well?

Is that something people really need to focus on as immediate relief, you know, along with food, water and medicine, that sort of thing? 

Jhumka: Absolutely. Menstrual health is a basic need, just like food and water, and it is often overlooked. I think, thankfully, there are some great organizations and humanitarian organizations that Have devoted time and efforts to period poverty, but I think in the general perceptions and the public response to humanitarian crises, whether it's a natural hazard or war zone, period poverty necessarily isn't what the at the top of what people perceive needs to be done, but it absolutely should be.

Georgia: Definitely, definitely agree with you on that. So if I could just move on a little bit maybe coming back to you Zeal, how important do you think it is to discuss these issues with adolescents and with children? And how, how do you think we can make these conversations inclusive? and safe for anybody that's part of a vulnerable community.

Zeal: I think that these conversations are key to mitigating period poverty because change, it begins at home. And I, I say that because I, from my own personal experience, if the family members and especially the female members of a household are not on board, With the practices, menstrual hygiene practices and whatnot.

I think that a lot of other ways of convincing people would be untimely because. There just wouldn't be the social support that's needed around, around menstruation, especially for people who are just coming of age and starting this. Just to again, go back to India and talk about some of the people who view menstruation, even in a very kind of a positive and a festive form.

And it's kind of like declaring to the entire. Village or in their, you know, their world that our daughter or, you know, my, my girl has just started menstruating and there is literally a full blown celebration around that. So it's something that for many cultures, it's a family thing, even.

Where, you know, people, again, women are shunned out of their homes if they're menstruating. So it's not really something that you. That you manage or carry out behind the closed doors of the toilet. But it's something that, that is more of a community and a collective thing. Now, a lot of other cultures are much more individualistic, obviously.

And in the modern society, you know, in the West, for instance a lot of people are autonomous, they make their decisions based on what they read or they consume information. Online a lot these days are even in some schools if they're lucky because a lot of schools, even in the U. S. They do not mandate any sort of menstrual education at all.

So I, I do think that if there are grassroots organizations as well as. The government even if there is some talk about it in the corporate sector about what menstruation is how do you manage it? And why is it important? That is probably this holistic approach that would really create the needed awareness.

Around menstruation and the practices or even, you know if you are dealing with a context where, again, if it's something that somebody wants to keep discreet then there can be one on one interactions with the people who are not otherwise getting access to these educational resources, focus groups can be another option as well.

But I do believe that if we want to create a massive ecosystem for the awareness around menstruation and you know, to make it inclusive and safe. Especially for those in vulnerable communities, then we need to incorporate it in a school education curriculum for both boys 

Priya: and 

Zeal: girls. 

Priya: I think also in the UK from our education, I remember just having maybe just one lesson where we just You know, they'd spoke about periods and, you know, that sort of thing.

And that was it. After that, there was no talk about it whatsoever. 

Georgia: It was very minimal. Yeah. Yeah. Kind of embarrassing, actually. Yeah, exactly. Sia, what about you growing up? Did you have it in school? Was menstrual education part of kind of social health as well? Like, were you taught about it or? Did you and your friends just have to learn it?

We 

Ziyu: have to learn everything all hour. Really? Yeah. Educating, like you just mentioned, educating boys as well is really important because when I was a kid in primary school, we, when we buy the period pass, we like the the shop assistant will Like automatically give you a black plastic bag to, to put your pads to hide it, to hide it.

Yeah. Wow. Yeah. And like the, the, that boy is just like making fun of them. So when we just like try to change the past, when we go to the toilet, we'll just like hide it. Like, Oh, did you, did you bring them? Pets? They like really secretly doing this. So I think if I like, now it's like so much faster because of the social media and everything.

People are know more about this. So it's like people are against like parrot shaming these days. So that's what education is really really needed to avoid this kind of. Definitely. 

Priya: So I guess the big question really is how can we reduce period poverty? So we've already spoken about education, but is there anything further that can be done?

And can I direct that question to Professor Cocktail? 

Jhumka: In addition to the discussion we've had, one thing I'd want to add is to really make sure whatever outreach is happening, that we really consider populations that have been made vulnerable. All right. So disabled populations, for instance who, you know, or or women who have conditions that are gynecologic in nature that can produce very painful periods like endometriosis or PCOS, and I think we need to do more research with these populations to really understand, for instance, Is a menstrual cup going to be suitable for them or is it too painful because tampons are often too painful for these populations.

I think also, and I'm talking a very US centric lens here but I think a lot of these things can apply elsewhere. is really looking at inequities within the population. We know from our research that black and Latinx students reported more period poverty than white women. And immigrant women reported more period poverty than U.

S. born. So, whatever efforts that are put forth, that we make sure that we're really engaging in a meaningful manner with these communities to ensure that the solutions that we propose resonate and that they're community driven as well. 

Georgia: That's so interesting. Thank you. Yeah. It's, it's very much not a, a one size fits all problem.

And it's really. Like you say, about kind of listening to specific needs and requirements of, of different communities and of kind of different people. That's yeah, such a good point. Thank you. So moving on, we've mentioned kind of a little bit about people making incredible progress in, in this sphere and young activists, Zeal, you mentioned as well.

So Zeal, has there been any kind of young activists that have come to your mind recently of the campaigning or anyone that you know that's maybe kind of just made some more progress in their own community? And breaking down stigmas or challenging taboos. Is there anyone in particular that you maybe were inspired by?

Ziyu: So one year, one year ago, Darren said a campaign on Weibo. Weibo is kind of like Chinese. A tutor. So it's like there's a company called Girls Help Girls. So basically because there are no paired products in the toilets, in the, in universities. So just like old school story or anyone?

Anyone. Right. , my experience, there's no pair of products. So we, we, and we actually set up a neutral eight box. So it's like, we put some of the paths there. So if you You suddenly has like your periods and you can take one and next time when you come back, you bring one back. It's like sustainable. Oh, that's such an amazing idea.

Zeal: Yeah, 

Ziyu: take one and, you know, bring back one. So it's like more than 300 universities like joined this campaign and set out like this neutral eight boxes in university. So I think that's pretty amazing. 

Georgia: That is amazing. And it's, it's still going on and people still kind of keeping that. Faulting it on.

That's brilliant. That's that's very inspiring and it's, yeah, what you think is just a small gesture can really kind of impact somebody's life and make them feel. Some safer. 

Priya: So do you think social media and spreading information on there can be helpful in terms of accessing information compared to its conventional methods?

Ziyu: Your friends is also using social media. Conventional media refers to like newspaper, radio. So it's not that well informed, especially young people these days can't really listen. To those radio anymore, right? So, but I think also there's some concern that. When, when it comes to social media, because the content sometimes can be really not regulated.

For example, some of I think it kind of like this is what men and men like, and like people have the stereotypes, like girls, when they have their appearance, like not easy to deal with stuff like that. So I was like, nah, nah, those may be something else. 

Georgia: Yeah. 

Ziyu: Yeah. 

Georgia: Yeah. That, that negative image and those kinds of stereotypes and quite frustrating expectations that, you know, you're going to.

be really grumpy or hormonal or something like that. That 

Priya: might not even be the case for everyone. That's the thing. Sorry. It's, it's definitely a story time. Yeah. Yeah, 

Georgia: totally. And again, assuming that everybody's going to know, you know, the same period and the same. It's going to have the same effect on them.

Can we also maybe direct that question to you, Professor Gupta? Is there something, you know, you were much kind of public health academic focused, but do you see people engaging in the right side of social media with it, or do you think it can sometimes be slightly misused as well? Like, so you mentioned.

Jhumka: Yeah. I mean, I think social media is It's a fantastic platform to disseminate information and there's always going to be the risk of misinformation and disinformation and that's why it's all the more reason for. Scientists the activists to really engage as well, and I think there's also efforts to really garner the use of social media in a scientific way to develop interventions to combat menstrual stigma.

I have a colleague who. Did she created a serious gaming intervention called Moham to educate on period poverty and it's like a game. People are playing games on their phones all the time. This is about period poverty. I'm actually in the process of developing a game based intervention to address stigma, using behavioral science and social norms.

And to really engage not just the adolescent girl herself, but also the people around her, the friends, the parents, the teachers, and how to really combat some of the harmful myths and actions to really take a bystander approach to. Combating menstrual taboos and also social support for things like endometriosis.

You 

Georgia: mentioned kind of some, some progress and some positive changes, but just sort of looking towards the future now, in the next five years, what actions and improvements do you expect or envision with looking to end period inequity? And maybe Professor Gupta, if you know, are you undertaking any more studies into this?

Are there, are there things that You perhaps are working towards in the 

Jhumka: public health sphere to change it. Yeah, we are we are launching another study with college students in Hawaii, really trying to look at similar patterns of inequities among college students in Hawaii. There's very definitely pockets of very underserved populations in that state, especially attending the state universities and.

I think more funding for this issue at the federal level would be especially important, both in the practical policymaking level, making period products available through SNAP, which is the Supplementary Nutrition and Supplemental Program, which is mostly for food, but not these types of products.

What I would like to see is Essentially period poverty being considered for any type of policymaking because whether people realize it or not, this is a public health crisis and it affects. It affects everyone whether they realize it or not. Right now the U. S. is facing a very significant eviction crisis.

And, you know, what happens to menstruators when they are evicted? That's a question that we have to ask. So, like, in every aspect of any type of policymaking social policy, also consider period poverty. 

Georgia: Do you have anything in the next five years, maybe, that you want to You want to see any specific changes or improvements, either here or in China, anything that you think you could really, you know, look forward to?

Ziyu: Well, I want to bring up, like, why interesting that, like, I find, I find that in the UK or most of the Western countries, people use tampons more than pads. I don't know if that's, if that, that's true, right? Use 10 words. I mean, 

Georgia: I'm not really sure about the stats, but yeah, I don't think so, maybe. I mean, I, I don't use INDRA anymore, so I'm not 100 percent sure, but possibly, yeah, I think maybe once you progress, once it's not sort of your first period anymore, people progress a little bit more towards.

Yeah, I'm not sure. Why? 

Ziyu: Because England, I hope people can, like, know more knowledge about parrot pond. Just because in China, like, like my friends, they don't really use tarpaulins. Because one time I just asked, oh, you're on a parrot, but you still want to go swimming with me. So you can try a tarpaulin.

They're like, oh, maybe I think that will break my virginity. Oh, okay. Okay. That's not true. So I hope in the next five years, people will, like, know more about the knowledge of this, about periods, yeah, and peer poverty and peer shaming. 

Georgia: Great point, yeah, the kind of social construct around that as well.

And Zil, any, any last sort of expectations or hopes for, yeah, next few years that you would like to see? 

Zeal: Yeah, I would love to see more talk, obviously, around sustainable menstruation. I don't think that's something that is being talked about enough. And again, I, I understand that it's not a one size fits all and behavior changes.

Extremely hard to do, especially habits you know, if we're just used to pads, it's very hard for people to start introducing, you know, a cup into, into their repertoire. So I, I definitely would like to see more of the sustainable lens on menstruation going forward. And not only that, because. There needs to be this basic understanding that we're all part of the same ecosystem.

We are nature, we're no different than nature, we're all connected. So the more we think about ourselves the more we should also think about others and the nature and the environment around us, it all goes hand in hand. And every action that we take obviously has. An impact and a reaction, and I hope that it's a positive one.

Priya: Okay, so final question. What is one thing you hope people will take away from your work? So let's go to Professor Gupton first. 

Jhumka: I think I'm going to repeat what I said, actually. It's just the idea that this is a public health crisis. It's It's not really talked about in schools of public health as much at the moment it's growing, but it's not quite there.

I think as we talk about other public health issues, like maternal child health timely antenatal care, the diabetes that we hope that period poverty and menstrual justice will enter the agenda for schools of public health and. Also, the idea that it's highly prevalent and so it, it affects people, whether they realize it or not, if not personally than somebody that they know.

Okay, great. 

Priya: And should we go 

Jhumka: over 

Priya: to Ziyu? 

Ziyu: Yeah. Okay. I hope people, like girls or boys, you've been listening to this podcast, just don't be shy talking about it. Just use all my resources as much as you can, and that's what I can, I hope, for the list audience. 

Zeal: And finally, Tazeel. I would go with the theme of change and how it is the only constant.

We need and we have to change every, you know, our bodies are constantly changing physically emotionally, etc. You know, all our senses are continuously being Regenerated. So I think that change when it comes to habits may seem hard initially, but dire problems need dire solutions. And we have seen that with the recent COVID pandemic, change is possible, change is necessary.

And there's always a way ahead. There is always a way to pivot to what serves us best in the current schema of things. And those who are most adaptable to those changes are we also scientifically prove one to thrive the most. So yeah, I would just end on the note that, you know, change is real and so is climate change.

And I think it's happening now. We need to act and we need to understand that it is real. 

Georgia: That's very true. Yeah. Well, as we've, as we've discussed in this in this episode, you know, there have been some amazing changes made recently, not only thanks to the three of you. So yeah, that just leaves me to say, thank you so much for joining us.

It's been a fascinating conversation. And we're really grateful to all for taking part. So thank you so much for joining us today.

Gavin: Thanks so much for joining us for this episode of the Lancet voice. This podcast will be marking the Lancet's 200th anniversary throughout 2023. by focusing on the spotlights with lots of different guest hosts from across the Lancet group. Remember to subscribe if you haven't already, and we'll see you back here soon.

Thanks so much for listening.