Menarche and our parent’s role

  

Puberty is a time of many changes. For young girls a defining event during this developmental process is menarche, which is defined as “the beginning of the menstrual function.”

Menarche according to Wikipedia, is the first menstrual cycle, or first menstrual bleeding, in female human beings. From both social and medical perspectives it is often considered the central event of female puberty, as it signals the possibility of fertility.

Menarche can be a stressful time for young girls, and the event is often met with mixed emotions. Like many other changes associated with puberty, it can be confusing. Many girls experience fear and anxiety related to their first menstrual cycle, largely because of misinformation or, more frequently, lack of information.

Girls who are prepared for menarche often have a more positive initial experience with menstruation. However, studies show that many girls are not prepared. In Delta women’s survey in involving 10 participants each from 25 local government in Delta State Nigeria, nearly one third of the respondents reported that they had not been told about menarche prior to its occurrence. Being caught unawares, the girls did not know what to do when it came.

Some of the most negative experiences have been reported by women who had no education about menstruation or menarche. In one study, when describing their menarche, women used words such as “panic,” traumatic,” embarrassed,” and “ scared” to recount their experience.

The sight of blood generally frightens people, since bleeding is usually associated with pain or injury. Thus, it is not difficult to see that when proper explanation or preparation is lacking, cultural stereotypes, myths, or even plain ignorance can cause one wrongly to associate menstruation with disease or injury or to view it as something of which to be ashamed. Young girls needs to know that menstrual bleeding is a normal process that all healthy girls experience.

There are many sources of information on menstruation, such as school teachers, health-care practitioners, printed material, and even educational films. Many parents find that these sources often provide valuable information on the biology of menstruation as well as menstrual hygiene. Still, girls may have questions and needs that these sources do not address. Even if they know what to do when their period comes. Girls are often uncertain about how to deal with the varied emotions and feelings associated with menstruation.

Mothers, older sister, and particularly grand mothers can help to provide the additional information and emotional support that young girls need. Most often, girls consider their mother to be most important sources of information about menstruation.

What about fathers? Many girls feel embarrassed to talk to them about menstruation. Some want their father to play an indirect role by offering support and understanding, while others prefer that he not be involved.

In some countries the number of single father households has increased over the past few decades.* Thus, more and more fathers will need to rise to the challenge of educating their daughters about menstruation. These fathers will need to be familiar with the basics of menstruation as well as with the other physical and emotional changes their daughters are facing. Fathers may choose to turn to their own mothers or sisters for practical advice and help in this regard.

Globally, the average age for menarche is generally between 12 and 13 years, although it can occur as early as 8 and as late as 16 or 17. In parts of Africa and Asia, the average age for menarche tends to be higher. For example, in Nigeria the average age is 15. Several factors, such as genetics, economic status, nutrition, physical activity, and altitude, can affect the timing of menarche.

It is best to start sharing information with your daughter before she has her first period. Hence conversations regarding body changes and menstruation should begin early, perhaps when your daughter is about eight years of age. You may feel that this is too early, but if your daughter is between the ages of eight and ten, it is likely that her body is already beginning to mature internally in response to surges of hormones. You will notice external physical changes associated with puberty, such as breast development and an increase in body hair. Most girls experience a growth spurt (rapid increase in height and weight) right before menarche.

Girls who are approaching menarche are often curious about what to expect. Likely they have heard other their peers at school discussing the subject. They have questions, but many have difficulty formulating exactly how to ask about it. They may be embarrassed about the subject.

The same is true for parents. Although mothers are usually the primary sources of information about menstruation, they often feel ill-prepared and awkward when discussing the subject.

Pre-teen girls who are approaching menarche are likely to understand simple, concrete information. Such information might include how often a period occurs, how long it lasts, or how much blood is lost. Thus, in the early stages of menstrual education, it may be best to focus on the more immediate and practical aspects of how to deal with menstruation.

You may wish to discuss details of the biology of menstruation. Oftentimes, you can get educational materials from health –care practitioners or from the library or book-store. Such reference works may be helpful in explaining the details. Some girls may prefer to read this material themselves. Others may feel comfortable if you read the material to gather with them.

Pick a quit place to start the conversation. Begin with a simple discussion about growing up and maturing. Perhaps you could says:

“Someday soon you are going to experience something very normal that happens to all girls. Do you know what it is?” Or a mother might start with a personal comment, such as:

“When i was your age, I started to wonder about what it was like to have a period. My friends and I talked about it in school. Have your friends started talking about it yet?” find out what she already knows about menstruation and clears up any misunderstandings. Be prepared for the fact that in your Initial conversations, you may need to do most if not the talking.

As a woman who no doubt experienced your own anxieties and concerns about menarche, you can draw upon your personal experience when discussing this subject. What did you need to know? What did you want to know? What information was helpful? Endeavor to provide a balanced view of the positive and negative aspects of menstruation. Be open to questions.

Menstrual education should be viewed as a continuing process rather than as a one-time discussion. You do not need to cover all the details in one sitting. Too much information all at once be overwhelming for a young girls. Children learn things in stages. Also, repetition of information on different occasions may be necessary. As young girls grow older, they are more able to understand additional details.

Another factor is that girl’s attitudes toward menstruation change throughout adolescence. After young girls gain more experience with their periods, they will likely face new concerns and questions. Hence, you need to continue to share information with them and answer their questions. Focus on what is most meaningful and appropriate for their age and ability to understand.

References

1.      ^ http://www.emro.who.int/publications/emhj/0601/06.htm

2.      ^ http://rmohamed.kau.edu.sa/Files/140/Researches/59054_29400.pdf

3.      ^ http://indox.org.uk/node/34

4.      ^ Anderson SE, Dallal GE, Must A (April 2003). "Relative weight and race influence average age at menarche: results from two nationally representative surveys of US girls studied 25 years apart". Pediatrics 111 (4 Pt 1): 844–50.doi:10.1542/peds.111.4.844. PMID 12671122. 

5.      ^ http://www.ncbi.nlm.nih.gov/pubmed/21110899

6.      ^ http://vstudentworld.yolasite.com/resources/final_yr/gynae_obs/Hamilton%20Fairley%20Obstetrics%20and%20Gynaecology%20Lecture%20Notes%202%20Ed.pdf

7.      ^ Magnússon, T.E. (May 1978). "Age at menarche in Iceland.". American journal of physical anthropology 48 (4): 511–4. doi:10.1002/ajpa.1330480410. ISSN 0002-9483. PMID 655271. 

8.      ^ http://pediatrics.aappublications.org/content/early/2011/06/08/peds.2010-2267.abstract

9.      ^ Frisch RE (August 1987). "Body fat, menarche, fitness and fertility". Human Reproduction 2 (6): 521–33. PMID 3117838. http://humrep.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=3117838. 

10 Field work 2012(delta state)

11 Wikipedia.

Written by

Agboje Okwualefe Peace, Egbonimali Shadrack and Kirthi Gita Jayakumar

Early Marriage and the “V” Word

Although Nigeria is a very multicultural and religiously diverse country, most Nigerians would agree that marriage is one of the most celebrated customs in the country. Both the wealthy and the poor invite their family and friends to partake in marriage ceremonies. Whether one is from the North or the South, merry cheers, laughter, music, dancing, and sharing food and drinks are part and parcel of a typical Nigerian wedding. Amidst all of these wedding ceremonies, society rarely places a spotlight on girls who are married off by their parents at an early age. Many of these girls later on become tormented by a physically, socially, and psychologically crippling phenomenon. This phenomenon starts with the letter “V”. V stands for Vesicovaginal Fistula.

Vesicovaginal Fistula (VVF) is developed during prolonged obstructed labour when the baby is pressed against the pelvis thereby restricting the flow of blood to the tissues in the vagina and the bladder which causes the tissues to die creating a hole between the vagina and the bladder. Young girls and early teenagers have a high risk of suffering from prolonged obstructed labour because their pelvis is not fully developed to allow for vaginal delivery. VVF also causes an uncontrollable leakage of urine which is accompanied by an unpleasant smell. The girls and young women who experience VVF are often abandoned by their husbands and families which illustrates why they are affected by this disease not only physically but also socially and psychologically.

There are 2 million cases of VVF around the world out of which Nigeria has between 400,000 and 800,000 VVF cases. 37 percent of girls between ages 15 and 19 are forced into marriage in Nigeria. VVF is particularly prevalent in Northern Nigeria where early marriage is widely practiced by people living in rural communities. According to Nigerian law, anyone below the age of 21 is allowed to get married provided that they have their parent’s consent. In North West and North Central Nigeria, the minimum age for marriage is 14; however, some families go as far as marring their daughters at the tender age of 11 or 12. The World Health Organization (WHO) reported that 70 percent of the VVF cases recorded in Nigeria come from the North. There are 20,000 new cases of VVF recorded annually in Nigeria and 90 percent of these cases are untreated.

One of the most influential factors that lead to early marriage is poverty. The International Centre for Research on Women (ICRW) noted that the poorest countries have the highest rates of child marriages in the world. Poor families are incentivised to marry their girls at an early age because first, the economic burden of raising that child would be relieved through marriage. Second, the family benefits financially from early marriage through the dowry or bride price which is customarily paid by the groom’s family to the family of the bride. Third, poor families would rather marry their female children then invest in their education. Some poor families prefer to send their boys to school then their girls. These supposed incentives for early marriage are the reasons why 80 percent of girls from poor households in Nigeria get married before the age of 18. In comparison, only 22 percent of girls from wealthy families get married before the age of 18.

When young girls marry at an early age, they are liable to also have a lower level of education and low economic status. Many girls who are married early are forced to also drop out of school. 

Young married girls are at a disadvantage of obtaining an education or employment because their household responsibilities, pregnancies, raising children and social restrictions prevent them from doing so. Education is one of the strongest factors to protect young girls from early marriage. UNICEF reported that studies indicate that higher levels of schooling for girls decrease the chances of early marriage. Girls who complete low levels of education, such as primary school, also have a lower risk of getting married early. Therefore, education is an important factor in the lives of young girls because it prevents them from getting married early and provides them with an opportunity to earn a living.

There are a few non-governmental organizations which focus on empowering or protecting the rights of women in Nigeria such as Women Empowerment and Legal Aid Initiative (WELA), Women Development International Association (WODIA) and the Foundation for Women’s Health, Research and Development (FORWARD). However, there is a need for such NGOs and other civil society groups as well as private individuals to work together towards increasing awareness across the nation about the negative consequences of early marriage. With 70 percent of Nigerians living in poverty, millions of girls who reside in rural communities are at risk of getting married at an early age and possibly developing VVF during the birth of their first child.

Currently, there are 36 million girls and women in Nigeria who are not educated. Educating a girl would not only help empower her by protecting her from early marriage, but also assists in the reduction of poverty in the country. By educating a girl, one is providing her with an opportunity to generate income, increase in the productivity of the labour market, and acquire knowledge which will ensure the health and wellbeing of her children. Educating a girl also increases the likelihood of her sending her own children to school.

Nigeria only has 13 centres which provide surgical treatment for VVF patients; these centres cannot cater for majority of the VVF cases in the country. While there is a need to increase these VVF centres and rehabilitation facilities, the best course of action for the Nigerian community would be to spread awareness on the negative effects of early marriage and the importance of education in the lives of girls. The Nigerian government’s efforts to fight poverty, illiteracy, and successfully enhance the development of the country are impeded by the failure to protect girls from early marriage and a life with no education.

The Damaged Womb

There is no gain saying that the health delivery system, especially in developing countries such as Nigeria, has ceased to be threatened by the activities of pseudo medical practitioners who often claim to have exhaustive knowledge of all dimensions of medical practice. The result of the activities of these charlatans, otherwise known as quacks, has
over the years been visibly detrimental to the nation's health status and this phenomenon has lately assumed an alarming and uncompromising proportion and so calls for a proactive and urgent attention, if the image of this nation must be redeemed and made to have a recognition in this regard in the world community.

Regrettably, the activities of such people apparently find expression among other things, in the administration of fake and expired drugs believed to aid the termination of pregnancy, insertion of unsterilized instrument such as foetus evacuation tubes and cutters, and the use of some locally made concoctions also believed to be efficient in the termination of pregnancy. A number of reasons have been advanced for the patronage of such quack medical practitioners. Such reasons range from the low cost of it to ignorance. However plausible these reasons might seem, the incontestable truth remains that the adverse effect of such act far out-weighs its purported good side, as it often results in either deformation of the unborn baby(that is if it is not successful) or termination of life. Such was the case of a pretty and promising young girl of 16 years of age(Named Onyero) in early 1993 in Alisimie community, Ika South Local Government Area of Delta State who had a recourse to such act.


According to her, the so called medical practitioner she went to see with her problem of unwanted pregnancy was a well known patient medicine dealer within the locality. The man(Mr. Abaye), middle aged, claimed to have got expert knowledge of the business. He had attended to countless number of persons before she became a victim. She was attended to and shortly after that, there arose some complications within her uterus. She began to bleed ceasely. This made her to go back to the man(Mr. Abaye) for remedy and she was given some medications which heightened the situation. She was left with no option other than to seek medical attention in the Central Hospital, Agbor where she was told that her womb had been damaged and all that was needed to be done to save her life was to cut off her womb. Till date, she remains without a womb and this has cost her two marriages as she could not bear a for her husbands. Today, she lives in regret, in pain and dejection as she has become a laughing stock within her community

The Joy of Birth or the Specter of Death?

Sourced from www.searo.who.int

Every minute a woman dies while pregnant or giving birth.  Women living in developing countries around the globe are especially at risk for dying from pregnancy-related complications.

Italy has the lowest maternal mortality rate (MMR) with only 3.9 maternal deaths per 100,000 live births. In contrast, Afghanistan’s MMR is 1,575.1 deaths per 100,000 live births, making it the country with the highest MMR in the world.  At the bottom of the list, close to Afghanistan, we find the Central African Republic, Malawi, Chad, Sierra Leone, Lesotho, and Cote d’Ivore. In fact, twenty-seven of the thirty countries with the highest MMR are African countries.

In Africa alone, a woman is 175 times more likely to die in childbirth than a woman in developed regions of the world.

Of the third-of-a-million women who die each year from pregnancy-related conditions, approximately three quarters could be saved if they had adequate access to reproductive health services.

Despite the fact that most of these deaths could be prevented, funding for reproductive health around the world continues to be threatened by politics and the ignorance of policymakers.

One clear example of this inexplicable war against reproductive health is recent United States legislation. During this past month, the U.S. House of Representative introduced a bill to cut funding for the United Nations Population Fund (UNFPA). Supporters of this bill have the erroneous view that the UNFPA’s main focus consists of providing abortions to women worldwide. Others suggest that the UNFPA is complicit in China’s controversial one-child policy, which enforces abortion and sterilization.

If you ask the UNFPA about their programs and interests, you will learn that they are a women and children’s health program that works to reduce maternal mortality, prevent HIV/AIDS and provide contraception to the world’s most vulnerable populations.

Remember the shocking maternal mortality rate in Africa? If the U.S. bill were to pass, in 2012 the UNFPA would be unable to prevent 7,000 maternal and newborn deaths, unable to provide surgeries to 10,000 women suffering obstetric fistulas, and unable to offer valuable contraception to about one million couples who otherwise would not be able to afford it.
    
My guess is that those countries with disproportionately high MMR will be the most affected if the cuts go into place.  That seems to be the curse of the poor worldwide. Once they thought it could not get any worse, some out-of-touch lawmaker on the other side of the world takes away the few resources available to them.

Where are abortions in this? After all, the proponents of the legislation claim that funding cuts will end abortions. Unfortunately, the reality is that the funding cuts will threaten the basic services that help save the lives of countless women and children worldwide.

Regardless of one’s views on abortion, most people agree on the importance of reproductive health. Millennium Development Goal 5 aims to reduce maternal mortality and to establish universal access to high quality reproductive health for all people in the world. In many people’s opinion, reproductive health should be a human right.

Yes, that is correct. Reproductive health should be a human right, not only a women’s right. If we want to defeat infections like HIV/AIDS and other sexually transmitted diseases, we must include men in our efforts as well. Planning a pregnancy not only depends on women, but also on men, whether it is by educating them on condom use, or on the benefits of contraceptives.

Like it or not, men are key players in decreasing the burden of risk and disease among women. Thus, they should also have equal access to reproductive health.

At this point, you might be somewhat unclear as to what exactly is reproductive health. The term surely gets thrown around a lot, especially around issues like abortion. However, reproductive health encompasses a lot more. In reality, reproductive health refers to a state of good sexual health. Having good reproductive health means having the ability to have a satisfying and safe sex life. It implies the capability to reproduce and the freedom to decide if, when and how often to do so. The right to reproductive health is the right to access safe, effective, affordable and acceptable methods of family planning. Most importantly, the right to reproductive health is the right to access health-care services to help women go safely through pregnancy and childbirth.

By making reproductive health accessible to those women who need it the most, we could potentially save over 200,000 women worldwide every year, the majority of which are in desperate need for these services.

The reality of our world is that for some women, childbearing and childbirth are sources of joy, love and much more. For other women, however, childbearing and childbirth are life-threatening episodes of life. Much of this could be prevented. While in developed countries most women can access the resources they need to conduct a good pregnancy, in many countries around the world women have to walk for days to get to the closest clinic. Oftentimes, women go on this walk even while in labor. Sometimes, when they reach the nearest hospital, the facility is empty as a result of cuts to funding and the resulting reduction in medical personnel and hours of operation. These are common realities for millions of women in the developing world.

We were all born to a mother. She was the one who gave us our life. Life is such a treasure that we have defined it as a human right. Then, if women are dying to give life, why is access to reproductive health not a human right? Why are we not making sure the funds go to the agencies in charge of preventing the death of so many women worldwide? Is the fear of abortion practices enough of an excuse to condone the death of so many women? I do not think so.

How can someone be pro-life and still overlook the fact that certain pro-life measures result in the death of many people? If you support life, then you should support access to reproductive health. After all, it is a human right.

Sources:
-World Health Organization
-Planned Parenthood Action Center
-United Nations Population Fund (UNFPA)


By Paola Brigneti