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+ 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