Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.) Chapter 5: Health Concerns of Girls (introduction...) Changes in Your Body (Puberty) (introduction...) Monthly bleeding (period, menstruation) Changes that Can Lead to a Better Life Deciding about Boyfriends and Sex (introduction...) Protecting yourself if you are ready for sex Pressured or Forced Sex Pressure to have sex with a boyfriend (‘Date rape’) If someone in your family tries to have sex with you (Incest) Young girls and older men Trading girls for money or other needs If you get pregnant and did not plan to Getting Help From Adults

Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 5: Health Concerns of Girls

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Sometime between the ages of 10 and 15, a girl’s body begins to grow and change into an adult body. These can be exciting and difficult years. A young woman may not feel exactly like a girl or a woman - her body is somewhere in between and is doing new things she is not used to. What can make it harder is when no one talks about the changes, and so a girl may not know what to expect. This chapter describes these changes, tells how a girl can stay healthy as she grows, and gives information to help her make the right decisions for a healthy life.

Eating for healthy growth One of the most important things a girl can do to stay healthy is to eat well. Her body needs to get enough protein, vitamins, and minerals during her years of growth. A girl needs at least as much food as a boy. Getting enough to eat leads to less sickness and more success in school, healthier pregnancies, safer births, and a healthier old age. Girls who get enough to eat do better in school. Girls also need the right kinds of food. When a girl begins her monthly bleeding she will lose some blood each month. To prevent weak blood (anemia), she will need to replace the lost blood by eating foods with iron in them. Also, girls and women both need foods with calcium to help their bones grow strong.

Changes in Your Body (Puberty)

All girls go through changes in their bodies, but the changes happen differently for each girl. So do not worry if your body does not look exactly like your sister’s or friend’s.

Growing. Your first change will probably be that you grow fast. You may be taller than all of the boys your age for a while. You will usually stop growing 1 to 3 years after your monthly bleeding starts.

Body changes. Besides growing fast, your body will begin to change. There are natural chemicals in the body called hormones that tell your body to grow and that make these changes happen.

How a girl’s body changes in puberty · You grow taller and rounder. · Your face gets oily and pimples or spots may grow. · You sweat more. · Hair grows under your arms and on your genitals. · Your breasts grow as they become able to make milk. As they get larger, it is common for the nipples to hurt sometimes. One breast may begin to grow before the other, but the smaller breast almost always catches up. · Wetness (discharge) starts to come out of your vagina. · Your monthly bleeding starts (menstruation). Figure

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Inside your body. There are other changes that you cannot see. The womb (uterus), tubes, ovaries, and vagina grow and change position.

¨ Changes of puberty do not all happen at the same time or in the same order.

What you feel. As you go through these changes you become more aware of your body. You may also become more interested in boys, and in your friends. There may be times when your feelings are hard to control. In the days before monthly bleeding, it is even more common to have strong feelings of all kinds - joy, anger, and worry, for example.

Monthly bleeding (period, menstruation)

Monthly bleeding is a sign that your body can become pregnant. No girl can know exactly when she will get her first monthly bleeding. It usually happens after her breasts and the hair on her body start to grow. Several months before her first monthly bleeding, she may notice some wetness coming from the vagina. It may stain her underclothes. This is normal.

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Some girls are happy when they have their first monthly bleeding, especially if they know what to expect. Girls who were never told about it often worry when the bleeding starts. It is something that happens to all women, and you can feel accepting and even proud of it. Do not let anyone make you think it is something dirty or shameful.

Caring for yourself during your monthly bleeding

Staying clean. Many girls prefer to make pads of folded cloth or wads of cotton to catch the blood as it leaves the vagina. They stay in place with a belt, pin, or underwear. The pads should be changed several times each day, and washed well with soap and water if they are to be used again.

Some women put something inside the vagina that they buy or make from cotton, cloth, or a sponge. These are called tampons. If you use tampons, be sure to change them at least twice each day. Leaving one in for more than a day may cause a serious infection.

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Wash your outside genitals with water each day to remove any blood that is left. Use a mild soap if you can.

Activities. You can continue all your regular activities.

It is healthy to bathe during your monthly bleeding.

Exercise can make the pain that some girls have with monthly bleeding feel better.

Changes that Can Lead to a Better Life

The way a woman sees herself forms as she grows. It is important that a girl learns to feel good about herself when she is young, so that she will be able to develop fully and help make her community a better place. A girl is much more likely to learn this when her family and community show her that they value her.

In many places girls are raised to believe they are less important than boys. They are taught to feel shame about their bodies and about being female, and they learn to accept less education, less food, more abuse, and more work than their brothers. This not only hurts their health directly, but it makes them feel bad about themselves and less able to make the right decisions for a healthier life in the future. When girls are raised in this way, it shows that their communities do not value them as much as males.

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But if a girl’s community recognizes the value of each person - whether the person is a man or a woman - she will grow up feeling she can make a better life for herself and for her family and neighbors.

A girl will feel proud if she sees that her efforts can make her community better.

The way a community treats females also affects how families treat their girl children. For example, if a community believes that girls should learn skills, a family that lives there is more likely to want their daughter to go to school for as long as she can. But in a community where women are allowed to do only ‘women’s work’ and are not allowed to participate in any public meetings, families are much less likely to believe that their daughters should be educated.

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There are many ways to help girls feel better about themselves and to help their families and communities understand that girls’ lives can be different. On the next few pages are some ideas.

Ways girls can work for a better life

Find someone to talk to who you think will listen and understand - a friend, a sister, or another female relative. Talk about your fears and problems. Together, you can talk about strong women in your community, your goals, and dreams for the future.

Do things that you and your friends think are important. If you see a problem in your community, get together with your friends to do something to change it. You will all feel proud when you see that your efforts can make your community better.

Try to plan your future. The first thing you can do to plan for your future is to set goals. A goal is something you would like to happen. For most girls this is not easy. Many feel their lives are controlled by their families or the traditions of their communities. But you can start to help yourself by knowing what you want. Figure Next, try to talk to a woman or man who works at something you would like to do. It could be someone you admire, or a leader in your community. Ask if you can spend time with that person to learn more about their work. Figure Sometimes girls feel frustrated because their dreams and hopes for their future may conflict with the beliefs in their community and family about what a woman should do. It is important to explain your dreams and hopes carefully to adults and to listen to their concerns also.

Decisions for a better future

There are important decisions that you can make with your family to create new possibilities for your future.

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Education and training. Education can help you feel proud of yourself, earn a better living, and live a happier and healthier life. For many girls, education opens the door to a better future. Even if you cannot go to school, there are other ways to learn to read and develop skills. For example you can study at home, join a literacy program, or learn a trade from a skilled person (apprenticeship). When you have new skills, you have something special to give to your community, and you can support yourself and your family better. Learning new skills can help you have more choices in your life.

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Waiting to get married. Talk with your family about waiting to get married until you feel ready and until you find the right partner. Many girls are able to finish school and find work before starting families. This can help you learn more about yourself and what you want. If you wait, you may even find a partner who feels the same way about life as you do.

Waiting to have children. It is easier to raise a happy and healthy child when you wait until you and your partner feel ready to start a family. If you are thinking about having a baby, these are some things to think about: Will you be able to continue your education? How will you fulfill the child’s physical needs - food, clothes, shelter, etc? Are you ready to provide the emotional support a baby needs to grow up into a healthy child? Will your partner commit himself to helping with child raising? How will your family help you?

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Parents and girls can work together to organize ways for girls to learn about how the body works, sexuality and prevention of early pregnancy. This can be done at home, and programs can be held in schools, community meeting places, or places of worship.

Deciding about Boyfriends and Sex

Decisions about boys and men are difficult. Most young people begin to have loving or sexual feelings as they get older. Thinking about touching or being touched by someone in a sexual way is not unusual. (Girls may even think about another girl or woman in this way.) But people often have these feelings before they are ready to act on them.

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Young women have sex for many different reasons. Some do it because they want to have a baby. Others do it because it makes them feel good or wanted. Some women feel they have very little choice because it is their duty as a wife. Some are forced to trade sex for money or for other things they need to survive, such as food, or clothes for their children, or a place to live.

¨ Only have sex when you decide that you are ready and know how to protect yourself from harm. Sex can be enjoyed by both people, but not if there is fear or shame.

Others have sex because they think it will make a man love them more. Sometimes a friend or a boyfriend can make a girl feel that she should have sex when she is not ready.

No one should have sex when she does not want to. Only have sex when you decide you are ready. Sex can be enjoyed by both people, but it is difficult to enjoy something when you feel fear or shame.

If you are ready for a sexual relationship, always protect yourself against pregnancy and disease. For more information on how, see the chapters on “Family Planning,” “Sexually Transmitted Diseases,” “AIDS,” and “Sexual Health.”

Health risks of early pregnancy Most girls’ bodies are not ready for a safe and healthy birth. Young mothers are more likely to develop toxemia (which causes fits) during pregnancy. Because their bodies may still be too small for a baby to come out, mothers under age 17 are more likely to have long, difficult labors, and blocked births. Without medical help, a woman with any of these problems can die. Blocked births can also damage the vagina, causing urine and stool to leak. Babies born to girls younger than 17 are more likely to be born too small or too soon. If you are already pregnant, try to see a trained midwife or health worker as soon as possible to find out how to have the safest birth.

What girls should know about having sex Figure · You can get pregnant the first time you have sex. · You can get pregnant any time you have sex without a family planning method (even if it is only once). · You can get pregnant even if the man thinks he did not let his seed (sperm) come out. · You can get an STD or HIV/AIDS if you do not use a condom when you have sex with an infected person. And you cannot always tell by looking at a person if he is infected. · It is easier for a girl to get a sexually transmitted disease (STD) or HIV from a boy or man than it is for her to give these diseases to him. This is because of the way sex works - because she is the ‘receiver’. It is also harder to know if a girl has an infection because it is inside her body. Always use a condom for protection against STDs and HIV/AIDS. But the most certain way to avoid pregnancy, STDs, and HIV/AIDS is not to have sex.

Having a relationship with no sex

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Building a loving relationship takes time, caring, respect, and trust from both sides. Sex is not the only way of showing someone that you care. Having sex does not mean that you will fall in love.

You can spend personal time together without having sex. By talking and sharing experiences you can learn something more important about each other - how you view life, decisions you would make together, what kind of partner and parent you would each make, and how you feel about each other’s plans for life. Touching each other (without sexual intercourse) can be satisfying by itself, and is not dangerous as long as it does not lead you to lose control and to have sex when you are not ready.

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Talk to your boyfriend. If you are sure he is right for you, but you are not sure you want to have sex, talk about ways to wait. You may find that he is not ready for sex, either. If you respect each other, you will be able to decide together

Talk to your friends. You may find that some girl friends are facing the same difficult choices. You can help each other find ways to have good relationships without sex. But think twice about advice from a friend who is already having sex. A friend may try to convince you to do something she is doing to make herself feel better about doing it. This is called ‘peer pressure’.

Protecting yourself if you are ready for sex

When you decide you are ready for a sexual relationship, you must protect yourself against pregnancy and disease. There are many ways to make sex safer. This means you have to plan before you have sex.

Talk to your boyfriend before you have sex. Let him know how important it is to protect yourself. If you find it hard to discuss, perhaps you can first pretend you are talking about another couple.

If he really cares about you, he will want to protect you. If he is pushing for sex, he may care only about himself.

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Many communities have people who are trained to provide condoms and other family planning methods. Talk to them or ask a health worker where to get a method of protection. If you feel embarassed to ask, find someone you trust to help you. Some family planning clinics have special services for teenagers and may have trained teenagers as peer counselors who can give you information.

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Since you cannot tell by looking if a man has a sexually transmitted disease or AIDS, sex is safer only if you use a condom every time. If a man has a discharge coming from his penis or a sore somewhere on it, he has an infection and will almost certainly give it to you!

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If you had sex and notice a new discharge from your vagina, sores on your genitals, or pain in your lower belly, you could have an STD. See the chapter on “Sexually Transmitted Diseases.”

Pressured or Forced Sex

Pressure to have sex with a boyfriend (‘Date rape’)

All over the world, young girls and women are forced to have sex when they do not want to. Often it is done by boyfriends who claim to love them. In some places this is called ‘date rape’. The force is not only physical. You can feel pressure from words or feelings. He may say “please” or somehow make you feel guilty or ashamed if you do not have sex. This is still wrong.

No one should be made to have sex when they do not want to have it.

If someone has forced you to have sex when you do not want it, it is rape.

Prevention:

· If he wants to have sex and you do not, you can tell him you are flattered by his desire for you but that you are not ready. If you are afraid of being alone with the person, bring someone with you, or ask someone else to talk with him.

· Say “NO” loudly if you are pushed to have sex. Keep saying “NO” if you have to. Also say no with your body. If you say “NO,” but give in with your body, he will think that you really mean “yes.”

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· Move away if you are touched in any way that you do not like. Your feelings are warning you that something worse may happen. Make a lot of noise and be ready to run if you have to.

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· Do not drink alcohol or take drugs. Alcohol and drugs make you less able to use your judgement and control what happens to you.

· Go out in groups. In many places, young couples court or date in groups. You can still get to know a boy, but you are less likely to be pushed into having sex because you will not be alone.

· Go only to safe places where others can see you.

· Plan ahead. Decide how much touching will be too much for you. Do not get caught by your feelings and let things happen to you.

If someone in your family tries to have sex with you (Incest)

It is never right for someone to touch you if you do not want to be touched. Family members, such as your cousin, uncle, brother, or father should not touch your genitals or any other part of your body in a sexual way. If this happens, you need to get help. Even if the man says he will hurt you if you tell, you need to tell an adult you trust as soon as possible. Sometimes it is best to tell someone outside your family such as a woman teacher or religious leader in your community.

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Young girls and older men

Some girls are attracted to older men. Going with an older man may seem very exciting, especially if he is well known or important in your community, or if he has money and can buy things. In some places a man who buys his girlfriend many presents is called a ‘Sugar Daddy’. Often a girl who goes with an older man ends up feeling she was used for sex or treated badly, especially if the man is married or has other women.

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Sometimes an older man can make a young woman feel more pressured to have sex than boys her own age can, especially if he has power over her.

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Trading girls for money or other needs

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Sometimes a poor family will give a young daughter to an older man to pay a family debt. Or they may trade her for money or something the family needs.

Sometimes the girls are taken away to another town or city. They think they are going to work in factories, or as maids, but they are often forced to have sex for money.

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If you think that you or another girl in your community is going to be sold into marriage, or sent away to work, try to get help from another adult. Perhaps an older aunt or uncle, or a woman teacher can help.

If you get pregnant and did not plan to

You may be pregnant if you had sex and your monthly bleeding is late, your breasts hurt, you pass urine often or you feel like vomiting. See a health worker or midwife as soon as you can to find out for sure if you are pregnant.

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Many young girls get pregnant when they did not want to. Some of them are able to get the support they need from family and friends. For others, it is not so easy.

If you are feeling trapped by a pregnancy you did not plan and you want to end the pregnancy, please be careful in the decisions you make. All over the world, girls and women die from trying to end pregnancies in dangerous ways. There are safe ways to end a pregnancy.

Talk to someone older who you trust Your life is too valuable to lose.

In many communities, a higher number of young women and girls are getting infected with the HIV/AIDS virus than any other group of people. There is more risk for girls who have sex with older men, but it can happen with a man of any age.

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Getting Help From Adults

Talking with your mother or father can be hard sometimes. Your parents may want you to live by tradition, but you feel that times are changing. You may feel that your parents do not listen or try to understand you. Or you may be afraid they will get angry.

Your family can love you without agreeing with everything you say. They may get angry because they care - not because they do not like you. Try to talk with them respectfully and help them to understand you better.

Ideas for better communication · Choose a good time to talk, when your parents are not busy, tired, or worried about something else. · Share your concerns, worries and goals with them. Ask what they would do in your situation. Figure · Give them something to read or show them a picture to get them started talking. You can read a part of this book together if it is related to your problem. Figure · If you get angry, try not to shout. You can make your parents angry and they may think you do not respect them. · If you have tried these things and you still cannot talk to your parents, find another older person you can talk to. It could be a teacher, the mother of a friend, an aunt, an older sister grandmother; someone in your place of worship, or a health worker.

How mothers can help their daughters

You may have grown up in a time when girls were not allowed to have an education, plan their families, or make decisions about their lives. Life can be different for your daughter. If you listen to her, share your own experiences, and give her useful information, you can help her make her own good decisions. You can help her to see the good things about being a girl and a woman.