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Girls are more likely to have sex, take sexual risks, and marry young if they menstruate early

Maternal and Reproductive Health, Global Health, Child and Adolescent Health, HIV / AIDS08. June 2017

The timing of a girl's first menstrual period can affect her first sexual encounter, first pregnancy, and her susceptibility to some sexually transmitted infections, according to a meta-analysis by researchers at Columbia University's Mailman School of Public Health. These patterns of sexual and reproductive health in girls in low- and middle-income countries who menstruated at an early age are similar to those seen in high-income countries such as early menarche and sexual and reproductive health in less developed economies. The results will be published online in the journal PLUS ONE.
Menstruation marks the beginning of a girl's reproductive life and is an important indicator of girls' physical, nutritional and reproductive health, but is often overlooked in public health, said Marni Sommer, Dr PH, MSN, RN, Associate Professor in Sociomedical Sciences at the Mailman School of Public Health and senior author. In high-income countries, early menarche is defined as being before the age of 12.
Columbia researchers used data from peer-reviewed studies and health and social science databases to assess the association between menarche and various adverse effects on sexual and reproductive health in adolescence. These included early sexual debut, experiences of sexual progress in older men, early pregnancy and childbirth, sexual risk-taking, and sexually transmitted infections, including HIV. The researchers also looked at the relationship between age at menarche and early marriage. Two of the studies were carried out in Malawi; the others were carried out in South Africa, Nepal, Jamaica, Nigeria, Zimbabwe, India and Bangladesh.
Overall, earlier menstrual age was associated with earlier age of sexual initiation, age at pregnancy, and first live birth.
A sample of Jamaican women who menstruated early had a 28 percent higher rate of sexual intercourse before they were 16 years old. In rural Malawi, 55 percent of those who had their first period before 14 had 27 percent of those with menarche between the ages of 14 and 15 and only 4 percent of those with menarche by the age of 16 or older. Few girls had sexual intercourse before menstruation began.
Girls who experienced menarche at an earlier age are also more likely to marry at a young age. In India, for example, a study suggested that the age of marriage rose by nine months for each year that menarche was delayed.
Despite possible similarities in the relationship between early menarche and sexual and reproductive health in low, middle, and high income countries, the factors associated with early menarche and early marriage may differ between ethnic groups within the same country, Mobolaji noted Ibitoye, MPH, DrPH candidate in the Department of Sociomedical Sciences at Mailman School and lead author. This underscores the need for a better understanding of the cultural and regional differences in the effects of menar age on marriage age, both within and between countries.
Studies from several high-income countries have shown that early menarche is also linked to various psychosocial factors such as delinquency, drug use, and depression, all of which have implications for sexual and reproductive health.
Although our analysis did not examine these patterns, it is urgent to examine whether similar associations exist in low and middle income countries, said Dr. Summer. Ultimately, this underscores the importance of including menar age in many other studies.
Mailman School of Public Health co-authors: Hina Tai and Grace Lee, Department of Sociomedical Sciences; and Cecilia Choi, Heilbrunn Department for Population & Family Health.

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