My Changing Body Puberty and Fertility Awareness for Young People 2nd Edition Institute for Reproductive Health Georgetown University 4301 Connecticut Avenue, NW Suite 310 Washington, DC 20008 USA Phone: 202-687-1392 Fax: 202-537-7450 Web: http://www.irh.org My Changing Body Puberty and Fertility Awareness for Young People 2nd Edition i My Changing Body: Puberty and Fertility Awareness for Young People 2nd Edition The first edition of this publication was developed by the Institute for Reproductive Health of Georgetown University and Family Health International in collaboration with Elisa Knebel. © 2011 Georgetown University, Institute for Reproductive Health The FAM Project Institute for Reproductive Health Georgetown University 4301 Connecticut Avenue, N.W., Suite 310 Washington, D.C. 20008 USA Email: [email protected] Website: www.irh.org The Institute for Reproductive Health (IRH) is part of the Georgetown University Medical Center, an internationally recognized academic medical center with a three-part mission of research, teaching and patient care. IRH is a leading technical resource and learning center committed to improving reproductive health worldwide. IRH was awarded the 5-year Fertility Awareness-Based Methods (FAM) Project by the United States Agency for International Development (USAID) in September 2007. This project aims to increase knowledge, access and use of FAM within a broad range of service delivery programs using systems- oriented scaling up approaches. IRH has also initiated a number of programs on body literacy and fertility awareness for youth and very young adolescents. IRH approaches body literacy and fertility awareness for youth as a way to help young people understand their maturing bodies and how to protect their own reproductive health. This publication was made possible through support provided by the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement No. GPO-A-00- 07-00003-00. The contents of this document do not necessarily reflect the views or policies of USAID or Georgetown University. ii Contents Acknowledgments ....................................................2 Overview ..............................................................4 Introduction for the Facilitator........................................7 Session 1: Puberty: My Body, My Self ...............................16 Key Information from Session 1 ............................35 Session 2: Female and Male Fertility ................................38 Key Information from Session 2 ............................50 Session 3: Combining Female and Male Fertility: Fertilization .....62 Key Information from Session 3 ............................82 Session 4: Concerns About My Fertility: Female and Male Group Discussions .....................98 Session 5: Hygiene and Puberty....................................112 Key Information from Session 5 ...........................116 Session 6: Review...................................................118 Evaluation: How Much Do You Know? ................................125 My Changing Body: Instructions for Parents .........................128 My Changing Body: Training for Facilitators .........................154 Glossary.............................................................181 Resources ...........................................................184 1 Acknowledgments My Changing Body, a puberty and fertility awareness manual for 10 to 14 year old girls and boys, was first published in 2003. Created by Georgetown University’s Institute for Reproductive Health and Family Health International, and available in English, French, and Spanish, the first edition of the guide has been widely disseminated in Asia, Africa, and Latin America, and people continue to download electronic versions of My Changing Body from IRH’s website. My Changing Body introduces the concept of body literacy and adds cross-cutting topics and activities that help youth become more aware of gender roles and other social changes that occur with the onset of puberty and developing gender identity and sexuality. This second edition includes a parents’ manual that aims to provide parents with information on puberty, sexuality, and gender as well as suggestions to help develop parent-child communication skills so that they may better support their children experiencing puberty in a world quite different from the one in which they experienced adolescence. Finally, this second edition includes a facilitators’ guide, which aims to help trainers and educators working with youth to improve their skills in participatory methodologies and facilitation, as well as gain critical information and comfort in talking about puberty, gender, sexuality, and fertility awareness, so they can better support Very Young Adolescents (VYAs) and parents reached by My Changing Body, 2nd Edition. Many individuals and organizations supported the development and field testing of My Changing Body, 2nd Edition, including (in alphabetical order): Bernadette Bimenyimana, Tom Caso, Dalila de la Cruz, Susan Igras, Marguerite Joseph, Rebecka Lundgren, Marie Mukabatsinda, Lorena Pahor, Elizabeth Salazar, and Aysa Saleh-Ramirez. We would also like to thank organizations involved in formative research that guided revisions, field testing of the second edition within existing youth programs, and in the curriculum evaluation of My Changing Body, 2nd Edition: APROFAM (Guatemala), Catholic Relief Services (Rwanda), and Caritas (Rwanda), National Institute for Public and Community-based Health (Madagascar) and SMART Consultancies (Rwanda). This manual reflects and builds on the work of other reproductive health and HIV/AIDS education curricula, including curricula from Advocates for Youth, CARE International, CEDPA, and HealthLink Worldwide. The Institute would like to acknowledge the contributions of FHI to the 1st Edition of this manual, which remains the foundation of this new edition. 2 Mihira Karra, the U.S. Agency for International Development AOTR for the Institute’s FAM Project, Jenny Truong, USAID Youth Advisor, and the USAID InterAgency Gender Working Group, have been strong supporters of the revision to the first edition as well as additional Institute efforts to further the VYA research and program planning and evaluation agenda. We also appreciate Melissa Adams and Torey Holderith for their work in helping to finalize this edition of the manual. Finally, the Institute is grateful to the U.S. Agency for International Development for its generous support and funding of this activity under the FAM Project, Cooperative Agreement HRN-A-00-97-00011-00. Institute for Reproductive Health of Georgetown University January 2011 3 Overview Why Choose My Changing Body? Human development, interpersonal relationships, personal skills, sexual behavior, sexual health, and sex in society and culture––there are many topics to cover when teaching youth about fertility, sex, and development! My Changing Body, 2nd Edition goes into detail about several of these topics, including fertility awareness and body literacy, using participatory activities. It is not meant to be a comprehensive sexuality education manual. Fertility awareness is a way to help very young adolescents (VYAs) understand their maturing bodies and how to protect their own sexual and reproductive health by knowing more about the signs of fertility and the physical and emotional changes that occur during puberty. This helps VYAs become knowledgeable about how their bodies function and empowers them to make appropriate decisions about sexual behavior. Helping VYAs understand their fertility increases comfort with their changing bodies and dispels myths and misconceptions about sexual and reproductive health better preparing them for adulthood. Body literacy explores what we are, how we came to be, and how our bodies function, in order to lead healthier lives. It rests on the premise that an understanding of one’s body should be approached both biologically and socially. In addition to understanding pubertal changes, being aware of gender role expectations and power relations enables VYAs to recognize how their sexual and reproductive selves are influenced by gender and social norms. Together, fertility awareness and body literacy empower VYAs in navigating puberty and attempt to fill the gap in knowledge and practice with a holistic understanding of one’s own body. Most parents, schools, youth organizations, and religious institutions are not well prepared to help VYAs understand and prepare for puberty, yet they want to help. VYAs often lack skills and information to deal with the many physical, emotional, and social changes associated with this time of rapid change and want advice and information from trusted adults. When VYAs are better aware of how their bodies work and what changes to expect as they become adults, they are much better prepared to deal with sexual and reproductive health issues and challenges. My Changing Body provides accurate, factual information about puberty in objective and reassuring terms for VYAs. What VYAs learn from My Changing Body will help them to become 4 more self-confident, practice good health habits, and gain a positive self-image as well as a greater awareness of gender stereotypes and issues that they deal with in their daily lives. My Changing Body is a fun and engaging manual for VYAs. Each session includes interactive activities, role-plays, games, and craft-making that not only promote the mastery of