I Still Can’t Stop Talking About Periods. I Just Have More to Say Now.

On Penn State’s campus of over 40,000 undergraduates, I earned a reputation as the “period girl.” I embraced the sobriquet because openness about periods was something I wanted more of in the world, and this was my way of practicing it. Now, I still can’t seem to stop talking about it.

I learned about the concept of “period poverty” when I was a junior in high school: the lack of access to safe and affordable menstrual products, resources, and education. Then, I began learning and reflecting about the role menstrual stigma plays in my life, in my friends’ lives, in my mom’s and sister’s lives, and continued seeking out opportunities to talk about this newfound passion. After I had committed to Penn State for my undergraduate studies, I searched for organizations dedicated to this topic and found Days for Girls PSU (DfG), which centered menstrual equity through sewing components of sustainable menstrual health kits and advocacy. Over the next four years, my Sundays became a rhythm of sewing and leading conversations about periods.

Leading DfG PSU meant serving as a resource for friends, peers, and faculty for all things related to menstrual health (including casual chats between classes about menstrual cups). I also focused on menstrual health in my academic studies. My Honors thesis argued that conversations about menstruation need to move toward embodiment, inclusivity, and body literacy. I was fortunate enough to present that work at the Society for Menstrual Cycle Research’s (SCMR) conference in 2023.

My passion for menstrual health did not wane after I earned my undergraduate degree; instead, it expanded to other facets of reproductive health. One month after graduation, I joined the American College of Obstetricians and Gynecologists’ (ACOG) Reproductive Health Access team, working to expand access to abortion, contraception, and miscarriage care. I heard from OB/GYNs in both abortion-hostile and unrestricted states, who described differences in implementing abortion care and contraception programming when supporting a clinic in Texas compared to a hospital in Illinois. As I became familiar with geographic and programmatic nuances, I became increasingly aware of the parts of health care that rarely make it into the public conversation: billing and coding requirements, hospital network policies, quiet infrastructure barriers. My understanding of “access” began expanding. Today, I see reproductive health as deeply intertwined with all facets of our lives; improving health outcomes requires critically examining the surrounding social systems.

Wanting to learn about the gritty intricacies of reproductive health, I chose to pursue my Master of Public Health at the Mailman School of Public Health because Columbia's Heilbrunn Department of Population and Family Health examines reproductive health beyond maternal health, and platforms menstruation as a serious part of that conversation. My decision has been validated: at Mailman, I've found professors who push students to look at issues in totality, ask hard questions, and build practical skills, surrounded by classmates who care just as much as I do.

Each student at Mailman completes an Applied Practice Experience (APEx) the summer between their first and second year, allowing students to begin applying public health competencies. For my APEx this summer, I served as the Menstrual Health Fellow for the GATE (Gender, Adolescent Transitions, and Environment) program. Over ten weeks, I dove into research about Menstrual Health and Hygiene in Emergencies (MHHiE). This project involves a question that sounds simple until you sit with it: When disaster strikes in the United States (US), is anyone thinking about periods? To help answer this question, I transcribed dozens of interviews from the study team’s data collection, spending hours with participants’ experiences and reflections until it was time to build a codebook (a set of codes, definitions, and examples used for identifying recurring themes and ideas across qualitative data), to analyze each interview.

When applying codes, I quickly learned that a single passage could touch on several ideas at once, and deciding how to categorize could either be straightforward or frustratingly ambiguous. Even after defining what each code meant, we repeatedly revisited where code boundaries were and when definitions had to be modified accordingly. While I learned an incredible amount about disaster response and attention to menstrual health, I learned even more about how to study a complicated question in the first place.

I have started to understand what keeps drawing me back to menstrual health over time. Menstruation sits at the intersection of so many of the questions I care about: gender, poverty, dignity, access, and, as this summer reminded me, even our ability to prepare for and respond to catastrophe. It may not always be the headline, but it is rarely separate from the larger public health questions underneath it.

More than anything, this summer reminded me why I turned to public health in the first place. At ACOG, I came to understand that access depends on the systems surrounding care. At GATE, I saw how research shapes the way we even conceptualize and talk about menstruation, which is work that is foundational to shifting those systems to begin with. Shifting a system looks different for everyone: sometimes advocacy, sometimes policy, and sometimes sitting with a transcript for an hour, debating where one code ends and another begins.

There are many exciting avenues this work could take me, but I aspire to help build systems better equipped to recognize what people need and make it possible to meet those needs. I’m still the “period girl” from Penn State, unwilling to stay silent about the topics I care about. What has changed is not what I care about, but how I understand the work of changing it. I’ll continue asking complicated questions, but after Mailman, I have a better sense of how to approach them.

Shaka Ramanathan is a second-year MPH student in the Population and Family Health Department, with a Certificate in Public Health Research Methods. Since her fellowship, she has continued working as a Research Assistant with the GATE Program.