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Voices from the Maine Youth Center

Who We Are and Who We Are Becoming

Adolescent Girls' Health Issues

Cultivating Hardiness Zones for Adolescent Girls

Girls' Health: An Action Plan for Maine


Talking With Girls:
Some Maine Girls' Perspectives
on Adolescent Girls' Health Issues


Discussions with small groups of girls or with individual girls took place during April and May of 2001. The intent of these discussions was to determine what girls consider to be their important health issues, whether they believed their health needs were being attended to, and to elicit their suggestions for ways to assist girls in getting the health services they require.

The thirty-two girls who participated in these discussions included girls from cities as well as rural areas, from northern as well as southern areas of the state, and from economically disadvantaged as well as affluent families. Note: though an effort was made to create a group that was diverse in many respects, this sample is small and not randomly selected and cannot be used for purposes of establishing statistical significance. 32 girls participated, 19 in middle school, 12 in high school, and 1 a freshman in college.

Participants were recruited by and discussions facilitated by Mary Orear, executive director of Mainely Girls. Specific adults, already known to Mainely Girls, who work with girls in various school settings, in after school programs, or in state institutions, were contacted about the possibility of setting up these discussions. Girls were assured of total anonymity and told that final survey reports would be sent to them.

The discussions lasted from 30 minutes to 60 minutes, and all except for two were conducted face to face. One was conducted over the phone and one via e-mail.

Each girl was presented with a sheet of paper containing the questions and was told that her answers would be confidential. Girls were also told that their statements should reflect their own experience or the experience of someone they personally know who is also an adolescent girl between the ages of 12 and 20 living in Maine, i.e. a sister, cousin, or friend. They began by listing all the health issues they considered most important. After the list was completed, the girls would discuss each issue individually in terms of whether the health care issue was being addressed adequately, what barriers posed problems, etc. The girls' comments as stated are not verbatim but were developed from the interviewer's notes.

The questions were as follows:

•What are the most important health care issues for you and/or other girls you know? (These can be physical, emotional, dental, etc.)

• Do you or girls you know have any problems getting health care needs met?

• If yes, what are the barriers that prevent you / others from getting what you need?

• What can be done about those barriers?


Girls cited the most important health care issues for themselves and girls they know:

Issue: Over weight - girls are concerned they're fat.

Solutions currently employed: To address overweight, girls participate in sports or join health clubs; some take diet pills or go on extreme diets.

Barriers to getting help: Being embarrassed to be seen working out or even seeming concerned about weight; not knowing what to do to lose weight; not getting help from anyone in losing weight.

Suggestions:Provide an effective diet and exercise program.


Issue: Depression is a problem for girls. (Girls attribute it to a variety of causes: abuse, family, school, so many cliques, the media.)

Solutions currently employed: Some girls take care of it by themselves; girls help each other; some girls go to a physician's assistant for help.

Barriers to getting help: Girls don't know that they have depression; afraid to tell someone that they are depressed because the community says not to and tends to shun these people - instead, girls just want to pretend they are happy; only a male guidance counselor at the school to talk to; sometimes can't find a good counselor who has time to see them; finding the right medication that works.

Suggestions: More education in schools about depression; possibly screening girls for depression in schools; people need to talk about depression; girls need to be told that a certain amount of depression is natural and normal, have more female counselors available; make medication more available.

Issue: Being disconnected and lonely and bored is a girls' health issue, especially for some girls with disabilities.

Solutions currently employed: Girls find someone to go to that they can spend time with and have fun and talk to openly and honestly. These don't have to be professionals but "everyday people" such as good friends or teachers. Girls also get involved in some activity, sport, club or project that keeps them busy and feeling normal and doesn't give them time to feel bad about themselves. This also helps provide a balance in their lives so they can appreciate the time that they do spend alone, and it prevents boredom and the resulting depression.

Barriers to getting help: None mentioned.

Suggestions: None mentioned.

Issue: Anorexia and bulimia - girls are obsessed about their bodies and how they look and what they weigh, which leads to nutritional problems, malnutrition, exhaustion, eating disorders, etc.

Solutions currently employed: Some girls' moms have struggled with this in the past and work with their daughters to prevent this happening to them; girls support their friends with eating disorders; some girls get the help they need.

Barriers to getting help: Girls' secrecy and shame; they think they can solve the problem themselves; they are afraid.

Suggestions: More education in school for girls about nutrition and about how serious anorexia is; educate coaches about not setting impossible body standards for their athletes and talking about the "perfect athlete's body;" be kinder to the girls with anorexia and bulimia; ban television; more positive non-skinny models and role models; acceptance of various sized models; more medical help; address the emotional issues involved and let girls talk about what's wrong; help girls find a new ways to express themselves.

Issue: Self-Mutilation- which several girls feel is tied to anorexia and bulimia.

Solutions currently employed: None mentioned.

Barriers to getting help: Fear their families will disown them; they don't want to stop because it makes the girls feel better; the girls like the attention; shame.

Suggestions: Talk to someone for help; educate girls about how serious it is.

Issue: Drugs and alcohol

Solutions currently employed: Prevention programs in schools

Barriers to getting help: Peer pressure - your friends encourage you to continue - you see it used in your own home; don't know where to get help; don't want help because of the pull of the drugs themselves; too scared of what will happen if they ask for help; afraid they will be put some place and kept against their will.

Suggestions: Publicize where girls can go to get help and what will happen for and to girls is they choose to ask for help; expose girls to ex-alcoholic and former drug addicted women to hear why and how they changed their lives.

Violence and Abuse

Issue: Physical abuse - violence perpetrated by brothers, fathers, husbands, boy friends, male coaches.

Solutions currently employed: Not standing up to the abuser for fear of risking further physical violence or verbal abuse; standing up to the abuser to protect mothers, siblings, self; getting emotional support from a physician's assistant.

Barriers to getting help: When you do speak up, you are retaliated against and often hurt.

Suggestions: Teach the police the skills necessary to address domestic violence; in small communities form a team including a doctor and a police person to address domestic violence issues; have more female coaches for girls' teams.

Issue: Verbal abuse - disrespectful comments, criticism, the destruction of one's reputation through spreading rumors - by boys and girls in school and in the community - leads to low self-esteem.

Solutions currently employed: Becoming verbally abusive yourself to make yourself feel better; courting social approval by putting down others.

Barriers to getting help: Society prevents girls from addressing the issue of verbal abuse; girls won't be seen as cool if they voice how they feel about the verbal abuse.

Suggestions: Work on accepting each other from middle school on and creating a more civil society; teach male coaches, referees and umpires about what verbal abuse is and forbid them to use it.

Issue: Domestic violence between parents and the results of divorce result in trauma and/or neglect for some girls.

Solutions currently employed: Some tell their friends who then confide in school staff.

Barriers to getting help: Ignorance that what the girls are experiencing is actually abuse and/or neglect; some girls are too afraid to speak up.

Suggestions: Educate young people about what constitutes abuse and neglect; when someone tells school staff or other adults about her concern over possible abuse or neglect of a friend, have the staff report back to the girl about what steps have been taken to help, i.e. counseling for the parent.

Issue: Unhealthy dating relationships, especially with much older men.

Solutions currently employed: Girls at one location mentioned a high school program that addresses this issue.

Barriers to getting help: None were mentioned.

Suggestions: None were offered.

Issue: Date rape and beating girls up while on dates.

Solutions currently employed: None suggested.

Barriers to getting help: Girls feel ashamed so don't ask for help; denial that it will happen to you.

Suggestions: More education about date rape and dating violence in schools.


Issue: Pregnancy.

Solutions currently employed: None mentioned

Barriers to getting help: Girls are embarrassed to be seen getting contraception for fear of what others might think of them; boyfriends don't want girls to use condoms.

Suggestions: Be more aware of the consequences of unprotected sex: teen pregnancy and std's; think before you act; tell a boy that if he won't use a condom, you won't have sex with him.

Issue: Lack of privacy & confidentiality in a small community by doctors' receptionists and pharmacists, about girls' health concerns.

Solutions currently employed: Girls don't seek medical help; girls go to different communities to get medical assistance; girls ask their moms to pick up girls' prescriptions, etc.

Barriers to getting help: Lack of sensitivity to girls' feelings.

Suggestions: None mentioned.

Issue: Sexually transmitted diseases.

Solutions currently employed: None mentioned.

Barriers to getting help: Finding a doctor who understands and is confidential and willing to help you physically and emotionally; not all doctors accept Medicaid.

Suggestions: All doctors should accept Medicaid.

Dental Health

Issue: Lack of professional dental care resulting in very bad dental health: cavities, broken teeth, gum disease and not having braces when needed.

Solutions currently employed: None mentioned.

Barriers to getting help: Parents who don't consider it important; lack of ability to pay; many dentists don't accept Medicaid; lack of transportation to get to the dentist; apathy.

Suggestions: Help parents understand they must make professional dental care a priority; create free dental clinics modeled on Family Planning or Planned Parenthood - and perhaps attached to them - where girls could access free dental care; the Lions Clubs could sponsor teeth as well as eyes; have dentists accept Medicaid.


Issue: Stress - Too much to do and no time for yourself; pushing yourself too hard.

Solutions currently employed: Finding the right specialist

Barriers to getting help: High expectations you put on yourself; pressure to perform and/or excel put on girls by coaches, school, others.

Suggestions: None mentioned.

Issue: As they become adolescents, girls' with disabilities who must meet and interact with educators, medical specialists, insurance company representatives, and employers with whom they've had no background or relationship, and many of these new people are ignorant or insensitive to the girls and their special needs. "My PCP has always been great, but with the specialists I've seen, I always take a chance."

Solutions currently employed: "My insurance company said I should have my parents call because I was too hard to understand." "I told the principal that he should spend a week in my chair and then he would understand." Learning how to say what she needs.

Barriers to getting help: People who won't take the time to try to understand what girls with disabilities need and/or are saying; underestimating the mental capacity of a girl with disabilities; being dismissive of the girl by insisting on consulting with her parents instead of with the girl; not making an attempt to learn about the girl's physical, mental and emotional capabilities; the girl not being able to verbalize what she needs.

Suggestions: People need to learn how to interact with girls' with disabilities, and that especially involves listening to them.

Observations and Conclusions

Toward the end of the interviews, individual girls in several different discussions pointed out how girls' health issues are interrelated. For instance, girls explained:

• Abuse results in low self-esteem.

• Low self-esteem is responsible for eating disorders, self-mutilation, and doing lots of drugs.

• Depression and eating disorders and self-mutilation are interrelated and result from pressure from society, parents and friends to look, act, and be a certain way, and to achieve, and a lack of accepting others as they are. The girls interviewed described an enormous degree of self-reliance. Instead of verbalizing to adults the problems they experience, girls often keep them inside or deal with the issues with their peers. Some girls seemed resigned to such a system, not questioning that more assistance with their health care concerns could or should be made available to them.

Though several girls said they lacked information about what would really help them address a health problem such as overweight or problem skin, only one girl mentioned the possibility of accessing current, helpful health information from a girls' health web site.

Several girls indicated the importance of seeing a female physician and said there is a lack of females physicians available. Two girls specifically mentioned the lack of access to women specialists in Maine.

What the girls considered their most important health care issues varied from one community to another. This suggests several possibilities:

----- some girls' aren't identifying certain issues as health problems because adequate care is available in their community.

----- not all communities of girls in Maine have the same health problems, i.e. anorexia didn't seem to be much of an issue in some areas, but in others it was a serious, wide-spread concern.

There isn't "one" experience for all teenage girls, and a Health Action Plan should remain cognizant of that.

Girls are describing problems on two levels: 1) the structural level, (i.e. lack of appropriate laws, information, etc. on the part of law enforcement agencies and the medical community), 2) the societal level, (i.e the socially constructed cultural norms for and expectations of girls). To successfully impact girls' health, we must address problems at both levels.

Another challenge is access. To solve or work on any of these problems, issue of access must be addressed.

The Girls' Health Action Plan should include the intention to identify girls' health issues specific to each community, to access what is already available to support girls' wellness around those specific issues, to determine what needs to be put into place, and to assure reasonable access for girls.