THE GROWING GIRLS PROJECT: EXPERIENCES OF PUBERTY AND MENSTRUATION IN A LOW-INCOME, MINORITY U.S CONTEXT
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Background: The transition through puberty is a critical period of sexual development that provides a prime opportunity to equip adolescents with accurate knowledge, positive attitudes, and beneficial skills that create a foundation for their sexual and reproductive health (SRH). Little is know about the present day puberty experiences of lower-income, minority girls in the U.S., who are at an increased risk for teen pregnancy and sexually transmitted infections, including HIV. This dissertation attempts to fill gaps in the literature by aiming to understand how low-income and minority girls in the U.S. describe and interpret their experiences of puberty and also to identify their psychosocial and information needs as they transition through puberty. Methods: To achieve these aims, a systematic review of the scientific literature published on lower-income girls’ puberty experiences in the U.S. was carried out. Following the systematic review, in-depth interviews and a longitudinal series of focus group discussions were conducted with 28 adolescent girls aged 15-18, who had recently completed their transition through puberty. This qualitative study was carried out in Baltimore City, Maryland. Twenty-five key informant interviews were also conducted. Results: The current literature revealed that low-income girls predominantly described their transition through puberty as negative and expressed having felt unprepared for their transition. Girls in Baltimore City similarly described their experiences of menarche as largely negative, shrouded in fear and confusion. They received varying levels of preparation for menarche, but most lacked even a basic understanding of the female reproductive system. Participants’ experiences of menarche highlighted eight main areas central to menarche preparedness, each of which contributed to how they felt about their first experience of menstruation. Participants also identified structural aspects of the school environment that influenced adolescent girls’ experiences of menstruating in schools, and described how multiple components of the built and policy environments impacted their ability to comfortably manage their menstruation at school. Conclusions: Together the findings from these three studies fill a gap in the literature on the present day puberty experiences of low-income, minority girls in an urban context in the U.S and highlight the need for improved puberty-related support and information for such girls. The limited existing evidence suggests that many low-income girls in the U.S. are unprepared for puberty and have largely negative experiences of this transition. Basic needs for menarche preparation are not currently being addressed for some girls in Baltimore City, and multiple structural aspects of school environments are negatively impacting their girls’ experiences of menstruating in school.