Contrary to established perception that early menarche (onset of menstruation) is a largely urban phenomenon,health workers from rural areas have been increasingly reporting that girls are attaining puberty early in their respective areas. So much so that the Health Ministry is looking at putting in place a counselling framework at the village level to help rural adolescents cope with puberty pangs.
Additional secretary and mission director NRHM Anuradha Gupta says: Field health workers are increasingly reporting that girls as young as 10 years are reaching menarche and often there is no support structure that they can turn to for physical and mental issues that come with puberty. They are not prepared and get overwhelmed. We do provide counselling facilities at the Adolescent Reproductive and Sexual Health (ARSH) clinics,but there is need for support more close to the children.
The ministry is looking at the feasibility of having peer counsellors in every village and has commissioned a study by the World Health Organisation (WHO) to look at the skill sets that these children would need to be equipped with,and what their kits would need to contain. The report is expected in the next two to three months. However,there is no actual data available with the ministry on age of onset of puberty of rural girls and planning at this stage is based on perception.
Early menarche is a now a well-documented phenomenon around the world though in India it has mostly been reported as a growing trend in urban areas. Gynaecologists say improved nutrition levels is a key factor as is greater exposure to sexual issues through cinema and television. A 2003 study in New Zealand even linked early menarche to the absence of a father in the household.
Under ARSH that was approved as a part of the Reproductive and Child Health II National Programme Implementation Plan (PIP),the key focus areas are promotion of good health practices,prevention of communicable infections like HIV-AIDS and counselling. However,the distance between the village and the ARSH clinic is often a limiting factor for its utility. That is where the peer counsellors may fill the gap,the ministry is hoping.
ARSH was originally instituted to tackle issues such as child marriage,child pregnancy and HIV/AIDS to make up for the parental opposition that sex education in schools encountered.
The idea of the clinic-based counselling was to provide the child with support as and when s/he was in need of it rather than risk a backlash.