Clara Mayfield and Olivia Pratt, second-year Master of Public Health (MPH) students specializing in Global Health, are currently researching menstrual poverty in the Himalayan region, specifically in the rural villages of Spiti Valley, located at more than 14,500 feet above sea level.
Menstrual poverty refers to the combination of challenges women face related to their menstrual cycles, including economic, environmental, health, educational, and social barriers.
Mayfield and Pratt became involved in menstrual poverty research following a mock pilot program for menstrual cups during a public health course on program planning, implementation, and evaluation, taught by Tejinder P. Singh. Inspired by this course, they traveled to India to conduct field research to understand the unique challenges of menstrual poverty in Spiti Valley and to develop solutions tailored to the region’s specific needs.
The MPH researchers sat down to discuss their ongoing research.
Tell us about your research on menstrual poverty.
Mayfield: One avenue of our research includes piloting and conducting surveys about menstrual cups. We are currently analyzing data on women’s knowledge, attitudes, and beliefs toward menstruation and menstrual cups.
Pratt: The second avenue of our research focuses on the role of men in menstrual poverty. We
conducted focus groups with men and women while in Spiti to gain a better understanding of how men could play a role in alleviating period poverty. We will use the findings from these focus groups to work with community health workers to develop a menstrual health curriculum for men in Spiti.
What challenges are associated with addressing period poverty in this remote, high-altitude location?
Mayfield: There is no centralized waste system. As women have transitioned from using reusable cloth pads to disposable products, they have the added burden of figuring out how to dispose of them. Additionally, any commercial menstrual product must travel a long way to get to the Spiti Valley. Accessibility in a remote area is complicated.
How do the residents of Spiti Valley contribute to your research?
Pratt: Spiti community leaders helped recruit participants, organized research blocks, and facilitated community discussions. Community members acted as translators and shared their ideas and beliefs with us. Ultimately, the people of Spiti decide what their community looks like, and their ideas guide all our research and interventions.
Can you share a positive outcome from your work so far?
Pratt: We worked with community leaders and Ecosphere to provide menstrual cups and an educational tutorial to 26 women in Spiti villages. We are now conducting follow-up surveys to assess satisfaction and hope the cups will improve menstrual management. We also had vulnerable conversations about menstruation with four groups of women and three groups of men—topics typically not discussed publicly. These conversations were a success, and we hope they encourage more discussion and awareness in the future.
What has been the most rewarding aspect of this research, and what have you learned through the process?
Mayfield: The most rewarding part of the trip for me was having the opportunity to immerse myself in a culture I’ve never experienced before. I love traveling because it exposes me to different perspectives and is extremely humbling.
I’ve learned that menstrual health challenges are so visible in Spiti, yet it truly is a global health issue. Waste is a big concern in Spiti because there is no way to get rid of non-decomposing trash. Menstrual cups are one of the possible solutions. Yet, people in the United States and across the world use disposable products and don’t think twice about it because our waste is taken away by a centralized system and hidden from sight. I have learned that we need to approach menstrual health from a global perspective because there is work to do everywhere.
Pratt: The most rewarding thing for me was to see a new perspective on a topic that I feel passionate about. This trip reminded me that there are many ways to view menstruation, and many cultural practices surrounding menstruation that are equally valid to my culture’s practices and beliefs. I also think it is empowering to learn about menstrual stigma and to see how it has impacted my own life and the lives of menstruators in my community.
I learned more about conducting community-based research and allowing the community’s decisions to guide the direction of the research. It was vital for us to communicate with community leaders and health workers before writing surveys and conducting focus groups to understand what questions we should be asking and how to keep discussions culturally appropriate. It was very valuable for me to work alongside community members, and to be guided by their visions for their own community.
If you're interested in joining this research initiative, please contact Clara Mayfield, Olivia Pratt, or Dr. Singh. Opportunities include work on menstrual health and other global health projects in India, as well as practicum and capstone options.