A study led by Dr. Marni Sommer, associate professor of sociomedical sciences at Columbia University Mailman School of Public Health, examined girls’ transitions through puberty in Madagascar and ways in which menstruation influences their educational experiences and future sexual health. The findings revealed gaps in the girls’ knowledge and an absence of support during puberty, varying guidance received about sexuality after the onset of menstruation and the challenges of managing menstruation in school.
“Given the significant gaps in girls’ levels of knowledge and support, there was a clear need demonstrated for educational material on puberty for early adolescents, along with teacher training about puberty,” said Dr. Sommer. The study also found that improved toilet facilities are critically needed to improve menstruating girls’ school-going experiences.
According to latest data, there are 145 pregnancies per 1,000 girls in Madagascar compared with an average of 95 per 1,000 for girls in eastern and southern Africa. Madagascar also reports one of the highest rates of early marriage in the world — almost 41 percent of girls are married by age 18.
Dr. Sommer and colleagues conducted qualitative and participatory research and identified the following themes: gaps in knowledge and timing of guidance delivered during puberty; caution regarding sex and sexuality after menarche; and challenges managing menstruation.
“Overall, we found that girls faced numerous challenges engaging actively in school while menstruating due to barriers in school environments,” said Dr. Sommer. “Girls in countries such as Madagascar have been lacking adequate guidance and information. To make a real difference in their lives, it is critical that we turn global attention to their needs.”