Puberty Among Very Young Adolescents

What norms contribute to this behavior?

Social norms are the perceived, informal rules that define acceptable, appropriate, and obligatory actions within a given group or community. Some social norms are specific to a particular context, while others may be broad enough to span multiple contexts; even seemingly contradictory norms may exist in the same context.¹

The following examples represent social norms relevant to puberty for very young adolescents (VYA; ages 10-18) that emerged from across the literature. They are not meant to be a comprehensive list of all relevant social norms or norms relevant in all contexts. 

• Boys and girls perceive that few of their peers have access to sexual and reproductive health information, support, and services^2–4 and that their reference groups would not approve of them seeking this information or services.^3–8
  Meta-Norms: Authority; Privacy; Protection

• In many settings, VYA boys and girls avoid asking their caregivers and other adults about the changing adolescent body, sex, and sexuality, as these topics are seen as taboo or impure subjects, particularly for adolescent girls, and discussion is considered inappropriate.^2–7,9–13
  Meta-Norms: Gender Ideology; Privacy; Protection

• Unmarried VYA boys and girls report difficulty accessing puberty, sexual and reproductive health and family planning information and services, due to perceptions that this behavior is only acceptable for married couples and that premarital sex is unacceptable.^{2,3,5–9,11,14} VYAs and their reference groups often express fears about VYAs being perceived as promiscuous or ‘impure’, if they access sexual and reproductive health information and services, especially VYA girls seeking family planning methods.^{2,3,6,7,9,11,15}
  Meta-Norms: Gender Ideology; Privacy; Protection; Social Status

• Double standards exist where boys are expected or allowed to exhibit sexual freedom and initiate sexual encounters with girls as a mark of masculinity, whereas girls are expected to protect themselves from boys’ sexual advances and when needed, take full responsibility for preventing pregnancy, even in cases of non-consensual encounters.^{5–7,9,11,14,16}
  Meta-Norms: Gender Ideology; Privacy; Protection; Social Status

• Parents and adult community members disapprove of relationships between young people, and may perceive adolescents to be too young to be able to make related decisions, such as avoiding premarital sex.^2,5,7 VYAs are also expected to show respect to parents and elders; their reputation is based on adults’ perceptions of adolescents’ good behavior.^2,3,5,7,14 VYAs hide their behavior (such as being in intimate relationships, reproductive health service-seeking or intimate partner violence) from adults to avoid sanctions and protect their reputation.^{2,3,5,7,8,11,12,14}
  Meta-Norms: Authority; Control and Violence; Privacy; Protection; Social Status

• Cultural expectations and taboos around menstrual practices and behaviors often result in secrecy and shame for girls.^3,14,17–21 Menstruation, if discussed, is often kept between girls and female family members, teachers, and health workers, even when adolescent boys express interest in learning about menstruation, thus perpetuating negative attitudes about menstruation and feelings of shame among VYA girls.^3,14,17–21
  Meta-Norms: Control and Violence; Gender Ideology; Privacy; Social Status

What other factors affect this behavior?

Very young adolescent (VYA) boys and girls are interested in learning about their bodies and changes during puberty, and need information, support, and services.  However, social expectations around what is appropriate for their age often make accessing information, support, and services difficult. These expectations may be different for boys and girls. Some common factors impacting access for both boys and girls may include belonging to low-income families, not attending school, or living in rural areas. Additional examples include:

Individual

• Socio-economic Status^1–4
• Ethnicity and Religion^1–6
• Disability³
• Sex^4,5,7–11

Interpersonal

• School Enrollment and Attendance^3,6,9,10,12
• Parents’ Education Level^4–6,13

Community/ Environmental

• Geographic Settings (Urban and Rural)^3,4,14,15
• High HIV/AIDS Prevalence Settings^4,9,16
• Post-conflict settings^9,17

Who influences this behavior?

The ability of VYA to access information, support, and services related to sexual and reproductive health is often dependent or heavily influenced by caregivers and other reference groups. Depending on context, reference groups can support or oppose information, support and services for very young adolescents.  These groups include:

• Parents/Caregivers and Family^1–10
• VYA Peers^5,9,11–14
• Teachers^3,8,9,15
• Health workers and providers^{4–6,8,16–18}
• Media^4–6,9,19

Selected interventions addressing norms and behavior

• The GARIMA Initiative was implemented by UNICEF and local NGOs with adolescents (10-19 years) in rural villages of three Districts of Uttar Pradesh, India between 2013-2016. GARIMA aimed to address social norms to break the culture of silence around menstruation by addressing underlying social norms framing menstruation as taboo and improving support and service seeking for menstrual health and hygiene. The intervention explicitly engaged multiple reference groups – peers, family, and community members – and power holders, including fathers and community leaders. These groups were engaged by providing spaces for caregivers to discuss and reflect on existing norms around menstruation and gender, promoting community dialogues to address norms that facilitate or constrain provider behaviors toward adolescent girls seeking menstrual health and hygiene information and services, and working with communities to identify and promote new positive norms such as peer and parental support for menstrual health and hygiene through street plays, radio programs, and films. GARIMA was evaluated using a post-test, cross-sectional case comparison design, which found that the intervention improved VYA communication about menstrual health and hygiene with caregivers and peers. A later evaluation also found that GARIMA improved social norms related to menstrual health and hygiene among VYA girls in intervention settings versus comparison settings. GARIMA measured norms using two methods; first, measuring injunctive and descriptive norms by focusing on personal beliefs and practices of menstrual hygiene behaviors such as using of materials, cleaning of menstrual materials, or attending school during menstruation, among other behaviors; second, measuring social restrictions and self-classifying them as personal, structural or social restrictions including restrictions around clothing, food, mobility and activities. Intervention villages reported significantly higher perceptions that other adolescent girls in their community approved of and practiced all eight desired behaviors than comparison villages. Girls in intervention villages reported more social restrictions versus comparison villages, however, in intervention villages, girls reported a significantly higher rate of challenging these restrictions.^1,2

• The Discover Learning Project was a community-based intervention implemented starting in 2016 in Dar es Salaam, Tanzania to provide social emotional learning opportunities with reflective discussions on gender and other norms for VYAs (10-11 years) in primary schools. An experimental project, Discover adapted each wave of implementation to reflect lessons learned in previous iterations. The intervention a six-week, after-school program, aimed to build positive socio-emotional learning, and actively engaged caregivers and other power holders to participate in discussions with VYA. Intervention components included educational video episodes of Ubongo Kids, culturally relevant learning content for school-age kids, reflective discussions in small mixed-gender groups, technology enabled experiential learning activities facilitated by a trained young adult from the community and a youth-caregiver workbook for facilitating discussions. An evaluation examined the impact of the program through qualitative in-depth interviews, focus group discussions, and participant observation. The transformation of gender norms, beliefs and behaviors, among other outcomes, were measured through qualitative, in-depth interviews with adolescents. Adolescent and caregiver participants reported improvements in social emotional mindsets and skills and community support, including shifting of gender norms and enhanced VYA-caregiver communication related to puberty and SRH. Both boys and girls reflected that working in mixed gender groups was a positive experience. Participants reported the equal value of boys and girls in finding solutions to problems and the importance of working together; specifically, they mentioned feeling competitive with peers before the intervention, but embracing cooperation and collaboration after the intervention. Participants described more gender equitable changes in their mindsets and behaviors during regular social play and other activities, such as collaborating to complete chores typically ascribed to the opposite gender.³