Community and Puberty
A Columbia Public Health student examined how a Tanzanian community approaches conversations around puberty and menstruation and discovered new ways to remove the stigma around often taboo topics.
Hurriedly stuffing a pad into your sleeve while you make a break for the bathroom at work or school. Saying “it's just a stomachache” instead of admitting to the cramps you’re feeling. Discreetly checking the back of your pants in a storefront window. These are all experiences that most girls, women, and other people with periods can relate to monthly. And while the world is more widely acknowledging the importance of talking about menstruation, it is often still treated as a secret to be protected and guarded.
It’s not just menstruation. Across many cultures and societies, conversations about body changes and puberty are also taboo, riddled with fear, anxiety, pressure, and a lack of understanding. For my practicum in the summer of 2021, I explored these conversations as the inaugural Sid Lerner Women’s and Adolescent Health Fellow with the Gender, Adolescent Transitions, and Environment (GATE) Program at Columbia Public Health. Throughout my practicum, we examined how youth in Tanzania received information about puberty, including analyzing findings from a faith-based approach to disseminating puberty content through local institutions, such as churches and mosques. The pilot effort led by the GATE team involved promoting a girl’s and a boy’s book previously developed by Dr. Marni Sommer and local colleagues in Tanzania, and distributed to churches in the city of Dar es Salaam. The puberty books were designed to be culturally relevant, with all illustrations being inclusive to the population they would be serving, and covering topics such as peer pressure, menarche, hygiene, etc. Church leaders shared the books with youth and parents in their congregations with the goal of encouraging conversations around puberty within the family. From there, the research team sought to analyze the acceptability and feasibility of distributing the books through faith-based institutions to the community, which included the team conducting interviews with girls and boys who received the books, their parents, and church leaders.
Before my practicum, I was unaware of how conversations around puberty are influenced by a person's culture or societal norms. Many cultures have traditions about how to talk (or not talk) about puberty and menstruation. For example, I learned many Tanzanian parents feel uncomfortable speaking about puberty, primarily due to stigma and cultural norms. From the data I analyzed, many parents only provided basic information when discussing these topics with their children, such as explaining how to use a pad. Not only does this pose an obstacle for young girls who have to navigate their first periods, but also for boys who may not understand, for example, why they are having wet dreams, and are too afraid to ask questions.
Growing up, I was heavily involved in my local church and I went to mass regularly, so with my work with GATE I was really fascinated by the use of faith-based organizations in the distribution of puberty education. I felt very comfortable at church, yet I could never imagine talking to my priest about puberty! Reflecting back, my discomfort and fear were due to the silence and sealed nature of the topic of puberty and menstruation. It was never included in our Saturday lessons or spoken about in mass, yet it was always looming like this forbidden secret for grown-ups.
As I became more involved with the GATE study at Columbia and as I read through all of the interview data, I realized that for this community within Tanzania, churches are heavily relied upon for counsel, and are integrated into all aspects of the community, making them one of the best resources for these tough conversations. The church leaders have spent years developing trust and confidence with their members, working to meet the needs of the community, including educating them about how their bodies will change.
When the churches recognized the need for their youth to know more about puberty, a number of them agreed to disperse the books. In turn, those who received the books and talked about its contents openly, likely did so because they believed that their church leaders would not lead them astray.
While Tanzania may seem far away with vastly different cultural experiences, similar stigma and silence surrounding puberty and menstruation can be found throughout the globe, including in the United States.
In recent months I began working at a non-profit organization in New York City that advocates for health equity. We have faced challenges with the issue of menstrual product access and puberty education in the community that we serve; residents are predominantly of Haitian descent and culturally wary of openly discussing puberty and menstruation. One intervention seeks to develop ‘health kits’ for our community health workers to distribute, prioritizing the houseless population. However, we face the challenge of how to distribute menstrual products to all menstruators; we want to be inclusive in our distribution while being mindful to not offend current cultural norms. Dealing with interventions around menstruation has many challenges, but one of my biggest takeaways from the entirety of my public health experience is that much of what we do is trial and adjustments in the hopes of one day getting it right.
This spring semester I took Dr. Sommer’s course "The Global Menstrual Health Movement", in which my classmates and I explored the complexities around menstruation, period products, access to toilets and water, and stigma. One of my key takeaways is that whenever you think you’ve opened all the possible doors in this world of menstruation - another one flies open. This world extends far beyond product access and stigma; there are doors on menstrual pain management; hormonal imbalances; the ways in which people with various physical/mental/intellectual abilities should be supported in managing menstruation; experiences of menstruation and non-binary folks, and more, creating a mass maze where all the doorways and hallways are connected, yet an end hardly in sight.
All of these experiences prompted me to challenge what I thought of as ‘normal’ when it comes to conversations about menstruation and puberty. I recognize that there can exist a world where we do not fear natural bodily changes and where we feel confident talking to our peers, family members, and health care providers about them. In reflecting on my growing time in the world of menstruation, it can be said that we all need a little more guidance to navigate the scope of bodily changes in all aspects – and not just for those who are currently undergoing the physical changes, but also in the conversations we have, the media we surround ourselves with, education in the products we use, and many more aspects.
Meagan Centeno is a 2022 MPH candidate in the Department of Sociomedical Sciences. She received a Bachelor of Arts in psychology for the State University of New York Geneseo.