Girls' Health: An Action Plan for Maine
Karen Heck, a consultant for the Maine Womens Health Campaign and Lisa Tuttle, staff to the MWHC at the time of the Girls Health Summit, were the principal authors of this report. Laura Ronan of Medical Care Development and MWHC served as the project advisor and editor. Additional invaluable assistance was provided by many reviewers, facilitators and planning group members.
Girls Health Summit Planning Committee
Maine Womens Health Campaign Steering Committee
Table of Contents
For additional copies of this document or the companion data review, Girls Health: A Maine Profile, please contact: Patricia Buck-Welton at Medical Care Development, 207-622-7566 ext. 256 or fax requests to 207-622-3616 or e-mail your request to email@example.com. You can also download a copy of the plan at www.MainelyGirls.org. For more information about the Maine Womens Health Campaign please contact Laura Ronan, MPH, firstname.lastname@example.org or 207-622-7566 ext. 238.
Background on the Maine Womens Health Campaign
The Maine Womens Health Campaign (MWHC) was launched in 1996 by several partners committed to enhancing the health of Maine women and girls, including the First Lady, Mary Herman, the Womens Health Equity Campaign, the Department of Human Services/Bureau of Health, the Department of Mental Health, Mental Retardation, and Substance Abuse Services, and public health and womens advocates.
Since that time, the Campaign has undertaken a number of activities that were recommended by participants at the Womens Health Summit sponsored by the MWHC in 1999. The Girls Health Summit, in fact, is one of those activities.
The Maine Womens Health Campaign envisions a future where all Maine women and girls will live healthy and safe lives, supported by their communities, and quality services and systems. The Campaigns unique mission is to encourage and support an environment that enhances Maine women and girls health by:
Why Girls Health?
Adolescence is a time when many health habits are formed and is therefore a critical time for public health professionals and others working with girls to assist girls and young women to make choices that provide the greatest chances for achieving and maintaining optimal health. While adolescent boys face some of the same issues and challenges that confront girls, girls health problems are often manifested in different ways. Girls are less likely to act out with violence than boys are, but more often experience depression, eating disorders, and sexual violence. Even though the positive health effects are well documented, girls participate less in physical activity and organized sports than do boys, and fewer resources are extended to support girls in sports. Current research has also found that during adolescence, girls are more likely to suffer a decrease in self-confidence, with social forces contributing to a decrease in girls positive feelings about themselves. Adults often treat girls and boys differently and frequently this treatment results in fewer opportunities available for girls to develop and express a strong, independent sense of self.
A variety of factors influence adolescents health. Household income, family structure, and racial and cultural identifications all affect attitudes, beliefs and behaviors related to health. Adolescence is a time of tremendous growth and experimentation, involving factors that are not always under an adolescent girls control. Experiences such as sexual assault and unsafe sexual behaviors can put girls at risk for immediate and long-term health and emotional consequences. Poor nutrition and physical inactivity can threaten girls healthy development and cause health problems later in life. Tobacco, alcohol and illicit drug use can occur as part of adolescent risk-taking behaviors, be used to alleviate the pain from untreated mental illness or trauma, and be combined with other behaviors, such as driving under the influence, to pose immediate threats to safety. (A thorough data review of the status of girls health in Maine was published May, 2001. It is available from the Maine Womens Health Campaign.)
Girls health is closely affected by their struggles to maintain a strong sense of self in the face of oppressive social influences. Current research warns us that overall girls, more than boys, face a decrease in self-confidence and positive feelings about themselves as they go through adolescence." This work also highlights how a narrow focus on girls psychology and self-esteem outside the context of analyses of broader social issues, can obscure girls strengths, overlook important cultural variations, deflect attention away from institutionalized inequities and contribute to a deficit model of girls capabilities."1
Development of the Plan
Girls Health: An Action Plan for Maine summarizes the results of the work accomplished at the first ever Maine Girls Health Summit held on June 1, 2001 at the Samoset Resort in Rockland. The Summit was sponsored by the Department of Human Services Bureau of Health, Medical Care Development/Maine Womens Health Campaign and Mainely Girls. Over 100 experts in girls development, health services, womens advocacy, social policy, service delivery, schools and community organizing attended the Summit to explore the issues that Maine girls are confronting and to craft strategies to ensure that they attain optimal health and well-being. Two companion documents, Girls Health: A Maine Profile and Talking with Girls: Some Maine Girls Perspectives on Adolescent Girls Health Issues were distributed to all Summit participants in order to provide an overview of the major demographic, social, economic and health indicators for Maine girls.
1 Phillips, L., The Girls Report: What We Know and Need to Know About Growing up Female, National Council for Research on Women, 1998, p.8. back
Summit Planning and Process
The planning process for the Summit involved professionals and girls with expertise in a wide range of issue areas. Initially, their discussion focused on which issue areas (e.g., tobacco use, eating disorders, suicide, etc.) were the most important to address at the Summit. It quickly became clear, however, that the action plan envisioned by the planning committee would be far more effective if participants could focus on the big picture". Specific issue areas dont exist in isolation but rather act together to affect girls health. Separating girls health from the context in which girls live their lives has both immediate and long term consequences for their development.
The Summit planners believed part of the problem facing girls is that women may keep silent about topics that are difficult to discuss and, often, controversial. They often arent willing, or perhaps feel powerless, to create an environment in which girls can flourish. This unwillingness, or powerlessness, extends to health care providers and others working with girls who feel themselves constrained by the system. Girls are often left feeling alone and without safe spaces to explore who they are and whats happening to them. As a result many girls are engaging in self-destructive behaviors.
Recognizing that it is the toxic environment in which girls are raised that negatively affects girls healthy development, the planners crafted the Summit goal below. Summit participants will create strategies to help themselves and others:
The Summit planners developed critical areas in which the development of objectives and action activities could begin to induce the environmental changes needed for girls to thrive. Using this framework, facilitators guided participants in small groups through the development and prioritization of objectives and activities.
To prepare Summit participants to craft the action plan, Lyn Mikel Brown, Ed.D., author of two books on adolescent girls development and Associate Professor of Education, Human Development and Womens Studies at Colby College, provided participants with an overview of girls needs and womens roles in creating hardiness zones. Her definition of a hardiness zone flows from the understanding that fertile soil is needed in order for plants to flourish and so it is with girls. A hardiness zone for girls is a place where girls can have control of their world. Its one that provides women and girls healthier lives with less violence and alienation and more support for who they are and who they want to be.
In creating hardiness zones for girls, we need to remember that just as plants grow differently in different parts of Maine, so Maine girls need different nutrients depending on whether they live in rural or urban communities, are economically secure or homeless, live in Aroostook or York, are native or immigrants, are white or of color. Hardiness zones remind us there is no typical girl, not even a typical white girl" so the strategies we create require us to move away from focusing only on self-esteem building or addressing depression, smoking or eating disorderssymptoms of individual stress and distressand to consider the social and political landscape in which a girl comes of age". 2
The MWHC, therefore, offers this plan as a starting point for supporters and organizers to begin the work of creating hardiness zones in Maine, for without changing the environment in which girls grow to womanhood, no matter what strategies we put in place to deal with individual behaviors and risk factors, the overall prognosis for girls health is not good. Here in Maine, we have a short growing season our soil is rocky, our land rugged, and as a result we have had to become amazingly creative in sharing gardening secrets and developing hardy plants like our mothers before us we are the tenders of flowers. Creating relational hardiness zones in our communities and state is about preparing a garden for all variety of girls so they can bloom profusely."3
This new understanding raises important questions about how girls are faring today in Maine and how we can best support their healthy, productive developmentboth physical and mental. For that reason, the MWHC hosted the Summit to develop strategies to assist parents, communities and providers in creating that support. We hope that readers of this plan will take the ideas Summit attendees have developed and expand on them to create activities specific to their own communities. Weve listed some of the specific activities discussed at the summit under each goal to help get the creative juices flowing but the activities are endless. The important point to take away from this plan is that by working together, exchanging ideas and information, speaking out, connecting with and supporting girls as they develop we can change the environment in which they grow.
3 Ibid. p.13 back
Implementation of the Action Plan
Girls Health: An Action Plan for Maine is intended to serve as a framework for a comprehensive statewide approach to improving Maine girls health. We envision that the goals, objectives and activities contained herein will set a collective direction and provide a focus for public and private efforts. As a framework, we expect this plan will need to be updated and revised as the work progresses.
Just as the framework for girls health and healthy development involves a multidisciplinary perspective inclusive of physical, mental, social, economic and political influences, so implementation of the action plan will require broad-based commitment from a range of state and local entities. The Maine Womens Health Campaign will continue to pursue the resources required to ensure that a coordinating body, dedicated to enhancing the health of Maine women and girls, will exist to facilitate the implementation process.
In implementing any pieces of the plan that focus on the provision of services, the MWHC urges all providers to develop services that adhere to the Society of Adolescent Medicines criteria to improve access to healthcare for all adolescents. The criteria describe services that are:
Key Stakeholders in Maine Girls Health
The following organizations represented at the Summit, along with others, will play a critical role in the implementation of the Girls Health Action Plan:
During the development of the major goals and objectives that constitute the plan, several themes emerged that cut across all of the content areas. These cross-cutting themes, some of which can also be translated into activities, are summarized in the following principles:
In order to effectively implement interventions, craft policies and increase our understanding of the needs and strengths of Maine girls, we must commit to including girls in all phases of activity. Public and private institutions, ranging from local organizations to the State legislature are encouraged to find ways to ensure that the voices, perspectives and opinions of girls are sought out and included in all activities that will ultimately affect their lives.
Maine girls are not a homogenous group; their experiences and perceptions differ widely depending on a variety of factors including their race and ethnicity, socioeconomic status, geographic residence, sexual identity, age, ability or disability and their connection or disconnection to schools, criminal justice facilities, shelters, foster care and group living situations. It is critically important to ensure that less visible populations of girls are included in efforts to improve Maine girls health and that activities are accessible physically, culturally and philosophically.
Summit participants understood the profound effects of bringing girls and women together in a variety of forums. Girls need strong, honest female role models who can inspire and guide them through the often challenging events of adolescence. Women also need open and productive dialogue with girls to hear the truth about their experiences and perceptions, and to understand the strategies they use to navigate often conflicting social expectations.
Activities to improve girls health must be based on the most current information and most promising models that are available. Throughout all phases of activity, ongoing assessment of progress and outcomes is necessary to ensure that strategies work.
Goals for Assuring Girls Healthy Development
The goals, objectives and activities formulated at the Summit were distilled to the following Key Result Areas:
Key Result Area: Community Development and Support
Acknowledging the importance of the community and family, participants in this group created strategies that will improve the capacity of local communities, families and schools to support girls healthy development and to develop interventions that will build upon and enhance the strength of girls.
In a current analysis of adolescent health, Robert Blum, MD, MPH, PhD, concludes that while many factors influence adolescents health, some critical risk and protective factors which are rooted in community environments emerge as potent predictors of health:
The Search Institute has identified community assets necessary for healthy adolescent development. The word assets" as used in the first goal of this section refers to the Institutes research on over 1 million 6th to 12th graders in the U.S. beginning in 1989.
Asset development" is a strength-based approach to healthy adolescent development that clearly shows the important roles that families, schools, congregations, neighborhoods, youth organizations and others in communities play in shaping young peoples lives.
4 Blum, R.W., Beuhring, T., Rinehart, P.M. (2000), Protecting teens: Beyond race, income and family structure, Center for Adolescent Health, University of Minnesota p.37 back
Access to needed services and resources, including health care, educational opportunities, and social, athletic and cultural pursuits is critical in order to ensure that Maine girls develop to their fullest potential. Maine girls have less access than boys to some resources. For example, fewer girls participate in regular exercise and organized sports than do boys, and despite the 1972 passage of Title IX which required that schools equitably offer athletic opportunities regardless of gender, many communities do not provide equitable physical facilities, financial resources and leadership. Additionally, while overall girls are catching up to boys in mathematics, they still lag behind in their achievements in science and technology.2 Subpopulations of girls, including those living in rural areas, those living in poverty, those from ethnic and cultural minorities, those with varying sexual identities and those living with disabilities have inadequate access to resources and services that are sensitive and appropriate.
In health care, girls face structural barriers to access, including the complex, adult-orientated patchwork service delivery and financing systems, and the lack of appropriately trained health care providers who are sensitive to adolescent and gender issues. Overwhelmingly, confidentiality concerns are cited as a barrier for girls who need health care services.
Its critical for educators to be aware of the connection between academic achievement and health. According to Blum, Being at academic risk is associated with nearly every health risk behavior studied Health and education are closely intertwined and school failure needs to be viewed as a health as well as an education crisis."3 In education and social services educators and service providers lack specialized training on the differences in risks and developmental issues between girls and boys. Social norms may preclude adults from recognizing their different treatment of girls, and the subsequent effects of these influences on girls ongoing development. Educators and service providers may be unaware of girls risk for sexual and domestic trauma, and the effects of these events on mental and physical health.
Key Result Area: Public Policy Development and Implementation
Good public policy is based on sound research. At the present time, there is little research addressing adolescent gender differences and even less data addressing issues faced by marginalized communities of girlsthose who are homeless, disabled, rural or of an ethnic background other than the majority culture. What research there is often does not take into account social and cultural contexts and girls voices are absent in discussions of policies that affect their lives.
Public and private sector policies have profound effects on womens and girls health and their access to appropriate, comprehensive services. Summit participants called for improvements in data collection and policies on the national, state and local levels, including those created at town meetings and by planning boards, school boards, churches, businesses, and state and federal governments. In order to ensure that appropriate policies are implemented, policies must be analyzed according to principles that support girls healthy development, model approaches must be identified, and good policies must be enforced.Summit participants called for action across legislative, judicial and administrative sectors to ensure that a comprehensive approach is launched.
Girls involvement in analyzing and crafting policies is particularly important when the policy decisions will facilitate or prohibit their own access to the information, resources and services they require for healthy development. Because the voting age is 18, many young women will be unable to voice their approval or disapproval of public policy at the ballot box. Therefore, efforts must ensure that their perceptions and ideas are gathered on the front end during policy development and that their ideas communicated to policy makers.
Summit participants acknowledged that including youth in policy development is frequently challenging to both the adults and youth involved in the process, yet promising models exist locally and nationally. Including girls voices ensures that the girls of today become tomorrows empowered, active leaders.
Key Result Area: Resource Allocation
As attention to girls health increases nationally and locally, increased resources will become available to support model approaches. Stakeholders invested in improving Maine girls health need access to coordinated information that can inform their efforts, alert them to promising models and methods and provide access to the resources required to sustain their work. Summit participants requested the creation of such a centralized, coordinating entity which would have the capacity to effectively link organizations and individuals, and disseminate critical information, policies and resources. Because the influences on girls development span diverse fields, it is likely that resources to support efforts will come from multidisciplinary sources. A central information source would be invaluable in helping stakeholders identify and access resources to support their work. At the same time, stakeholders need to take the initiative to inform funders of the ways in which girls health has an impact on the kinds of activities they are currently funding. Foundations often arent aware of the interconnectedness of adolescent environment and health.
Another invaluable resource participants identified in their discussions are the people who are currently working in the field. The importance of providing opportunities to network with others appeared throughout their recommendations. People who have been working in the area of girls health are often unaware there are others, sometimes within their own communities, working on similar issues. The need to bring people together and to keep them connected is critical for sharing knowledge and expertise and to supporting those working to bring about social changes.
Throughout the state, women and girls need, want and deserve mechanisms that will facilitate the exchange of information and ideas and provide support for ongoing action to improve girls health. Formal and informal forums that engage intergenerational groups invested in advancing girls health will strengthen individual and organizational investment and provide critical support to individuals involved in the work.
A Final Word
The goals, objectives and activities listed here create a broad outline of the areas in which we need to work to generate the changes we know are necessary for girls to bloom and grow. We hope that the ideas generated by the Summit participants and recorded here will be a jumping off point for all groups working to develop healthy, hardy girls. We encourage those reading the plan to join with others and use their collective ideas, energy and enthusiasm to create hardiness zones wherever the soil exists!