Study illustrates gaps in knowledge and lack of support for girls during puberty

A study led by Marni Sommer, DrPH, RN, associate professor of Sociomedical Sciences at Columbia Mailman School of Public Health, examined girls' transitions through puberty in Madagascar and ways in which menstruation influences their educational experiences and future sexual and reproductive health. The findings, published in the Journal of Early Adolescence, revealed gaps in the girls' knowledge and an absence of support during puberty, varying guidance received about sexuality after the onset of menstruation and the challenges of managing menstruation in school. Until this study little had been known about girls' experiences of puberty in Madagascar, which has among the highest rates of adolescent pregnancy compared with those in other parts of Africa.

"Given the significant gaps in girls' levels of knowledge and support, there was a clear need demonstrated for educational material on puberty for early adolescents, along with teacher training about puberty," said Sommer. The study also found that improved toilet facilities are critically needed to improve menstruating girls' school-going experiences.

According to latest data, there are 145 pregnancies per 1,000 girls in Madagascar compared with an average of 95 per 1,000 for girls in eastern and southern Africa. Madagascar also reports one of the highest rates of early marriage in the world—almost 41 percent of girls are married by age 18.

Adolescents are the fastest growing population group around the world, including over 1.6 billion young people aged 10 to 19 years, the majority of whom live in low-income countries according to most recent UN data. Adolescent girls in particular are vulnerable in such contexts to negative sexual and reproductive health outcomes.

To understand the girls' experiences of early adolescence and puberty and the intersections of menstruation with their schooling, Sommer and colleagues conducted qualitative and participatory research—the latter which has been shown to empower participants.

The researchers identified the following overarching themes:

(a) gaps in knowledge and timing of guidance delivered during puberty;

(b) caution regarding sex and sexuality after menarche; and

(c) challenges managing menstruation.

The latest study, conducted in partnership with Projet Jeune Leader, confirmed earlier ongoing research by Sommer which showed that girls often receive inadequate guidance and support about their sexual and reproductive health and inadequate access to safe, hygienic water. Toilets in schools were found to hinder girls' ability to manage menstruation safely. "This, in turn, may reduce their active participation in the classroom," according to Sommer.

"Overall, we found that girls faced numerous challenges engaging actively in school while menstruating due to barriers in school environments," said Sommer. "Girls in low-resource countries such as Madagascar have been lacking adequate guidance and information. To make a real difference in their lives, it is critical that we turn global attention to the needs of girls and to early adolescence as a critical stage of transitioning to a healthy adulthood."