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Talking
With
Girls:
Some Maine Girls' Perspectives
on Adolescent Girls' Health Issues
Method
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?
Responses
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.
Depression
• 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.
Sexuality
• 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.
Stress
• 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.
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