growing up in tajikistan: how to use puberty · growing up in tajikistan: how to use puberty...

+ Growing up in Tajikistan:

How to use puberty research to better inform

MHM interventions

Gloria Driessnack Sclar Save the Children International Rollins School of Public Health, Emory University

+ Tajikistan Context: •  Central Asia •  Soviet past •  98% Muslim

Literature Review: •  Limited puberty

research •  Menstruation affects

school attendance (Mooijman, 2002)

School Health & Nutrition Team: 2014 Summer Goals

n Research Goal: To conduct interactive focus group discussions with schoolgirls and boys to learn about their experiences, knowledge and perceptions of puberty.

n Program Goal: To translate research findings into the design of context-appropriate puberty books.

Ideal Facilitator Team! •  Close relationship with schools •  Child-to-child trainings •  Doctors, teachers, women councilors by training

Key Informant Interviews

n Biology Teachers n What are girls taught in school?

n Girls’ Councilors n What support do girls have in

school?

n MoE Biology Specialist n What content is appropriate for

the books?

n MoH Gynecologist n What health messages are

important to include in the books?

Book Committee

Methods: Focus Group Discussions

UNICEF WinS Tools + Marni Sommer’s Work à Designed Activities

Methods: Data Collection

Girls Boys Women Focus Groups 9 7 6

Participants 79 57 20 teachers 25 mothers

Activities -Becoming an adult -Imagining the life of a girl -Story writing

-Becoming an adult -Gender roles and equality -Story writing

-Puberty book recommendations -Challenges for girls -Story writing

Districts Bokhtar, Jomi, Khuroson, Sarband, Vakhsh

Thematic Analysis Approach

n Steps n Translate written activity data from Tajik à English n List each theme that arises n Collapse into main themes n Count frequency

Main Theme Subthemes Relationships change (9)

•  Relations with others change / when get menstruation (4) •  Respect parents and elders more / Take care of old

parents (2) •  Misunderstanding between girls and parents (1) •  Attitude of parents/adults will change towards her (1) •  Find new friends (1)

Results

Activity Main Findings Body Changes Can identify major changes

Frequently discuss menstruation Focus on beauty

Results

Activity Main Findings Body Changes Can identify major changes

Frequently discuss menstruation Focus on beauty

Life Changes Starting family / marriage Change in behavior, feelings Focus on beauty Education

Results

Activity Main Findings Body Changes Can identify major changes

Frequently discuss menstruation Focus on beauty

Life Changes Starting family / marriage Change in behavior, feelings Focus on beauty Education

Positives Appearance and beauty

Negatives “Life becomes difficult”

Beco

min

g an

Adu

lt

Results

Activity Main Findings Body Changes Can identify major changes

Frequently discuss menstruation Focus on beauty

Life Changes Starting family / marriage Change in behavior, feelings Focus on beauty Education

Positives Appearance and beauty

Negatives “Life becomes difficult”

Menstruation Challenges

1.  Being prepared 2.  Seeking help from others 3.  Being confident

Beco

min

g an

Adu

lt

Results

Activity Main Findings Body Changes Can identify major changes

Frequently discuss menstruation Focus on beauty

Life Changes Starting family / marriage Change in behavior, feelings Focus on beauty Education

Positives Appearance and beauty

Negatives “Life becomes difficult”

Menstruation Challenges

1.  Being prepared 2.  Seeking help from others 3.  Being confident

Beco

min

g an

Adu

lt

Menstruation stories

Theme Subthemes Frequency Menstruation Character

Girlfriend 27

Author 14

Menstruation stories

Theme Subthemes Frequency Menstruation Character

Girlfriend 27

Author 14

Setting School 34

Home 6

Marriage party 3

Menstruation stories

Theme Subthemes Frequency Menstruation Character

Girlfriend 27

Author 14

Setting School 34

Home 6

Marriage party 3

Physical Reaction Body pain 9

Skin turned white 5

Without energy 5

Menstruation stories

Theme Subthemes Frequency Menstruation Character

Girlfriend 27

Author 14

Setting School 34

Home 6

Marriage party 3

Physical Reaction Body pain 9

Skin turned white 5

Without energy 5

Emotional Reaction Afraid/scared 24

Shy 10

Menstruation stories

Theme Subthemes Frequency Menstruation Character

Girlfriend 27

Author 14

Setting School 34

Home 6

Marriage party 3

Physical Reaction Body pain 9

Skin turned white 5

Without energy 5

Emotional Reaction Afraid/scared 24

Shy 10

Social Support Author 25

Mother 12

Girlfriend 11

Menstruation stories

Theme Subthemes Frequency Menstruation Character

Girlfriend 27

Author 14

Setting School 34

Home 6

Marriage party 3

Physical Reaction Body pain 9

Skin turned white 5

Without energy 5

Emotional Reaction Afraid/scared 24

Shy 10

Social Support Author 25

Mother 12

Girlfriend 11

Example Story

“My friend Sitora got menstruation during the lesson. At first Sitora wanted to tell me about her problem but she

was shy. Later I saw that she was without energy and her face was white and she asked for my help. She told me her problem. I went to teacher. I got permission from teacher to

take Sitora to her house. At the road I gave her some advice and information about menstruation because I had

my menstruation before.”

Puberty research reveals richer story

Menstruation aspects for Tajik girls

•  “School story” •  Supportive girlfriends •  Afraid & shy •  Physical reactions •  Behavior change •  Cotton cloth •  Lack of prior knowledge

•  Become beautiful •  Healthy body (pregnancy) •  Relationships change •  Become shy •  Help others

Menstruation activities Puberty activities

Translating Findings à Puberty Book

n  Introduction to puberty

n Physical changes

n Emotional changes

n Self-esteem

n Relationships with others

n Safety for young girls

n What is menstruation?

n When will I start menstruation?

n How should I manage my menstruation?

n What should I do if I feel pain?

n How can I prepare?

n Who should I go to for help?

n What should I do in school?

Puberty Menstruation

Next Steps: Puberty Books

Design

• SHN staff make edits and changes • Artist creates illustrations • Put together final layout design

Edit • Book committee reviews content/design

Approval • MoE and MoH approval process

Test

• Pilot test books with schoolgirls, mothers and female teachers through collaboration with Girls’ Councilor

+Acknowledgments