Even at an early age, Mary Arnold, PHN, RNP, was trained to be a caregiver. Growing up in Memphis, Tenn., she learned to administer insulin shots at the tender age of nine to her grandmother who had diabetes.
"I have always played a role in healing," says the Piedmont, Calif.- based nurse practitioner.
Arnold’s nearly 35-year nursingc career began in 1975 when she graduated from the LPN program at Memphis Area Technical School. A short time later, she decided to continue her professional education to become a registered nurse, attending classes at Memphis State University and Methodist Hospital School of Nursing.
"I was a single mom at the time and one of my instructors told me that a single parent had never graduated from the nursing program," Arnold recalls. "That comment only served to challenge me and reinforce my commitment to [advancing my] education."
After receiving her RN licensure in 1979, she worked in critical care, med-surg and respiratory care units before finding her true calling in women’s health. She moved to the San Francisco Bay Area in the early 1980s and enrolled at San Jose State University to pursue her dream of becoming a women’s health nurse practitioner.
Today Arnold is living out that dream by helping young girls and their families navigate the journey from childhood to womanhood with her successful "Girltalk" education program. Since 1996, she has been leading mother-daughter Girltalk workshops that teach prepubescent girls aged eight to 14 about the female reproductive system, puberty, menstruation, personal hygiene and the responsibilities of becoming a young woman. To date, over 400 girls in the Bay Area have participated in the program.
"These topics can be confusing for young girls, especially when they are still in elementary school," Arnold explains. "I remember years ago when some nursing colleagues and I were discussing how we had felt when we first got our menstrual periods and noticed our bodies were changing. So many of us weren’t prepared and we wished we had been given more information. That time in our lives would have been less scary if we had known what to expect."
A Too-Early Start
Arnold points out that many girls today—and especially African American girls—are entering puberty at a much younger age than their mothers and grandmothers did. They are showing signs of puberty, such as breast and pubic hair development, as early as age seven or eight and beginning to menstruate two to three years later. A study published in the March 2007 issue of New Scientist magazine suggests that increasing rates of childhood obesity may be linked to the dramatic increase in early-onset puberty in girls. Other studies have cited such possible factors as genetics, low birth rate, poor nutrition, lack of physical activity and exposure to environmental toxins.
Whatever the reasons behind this trend, many parents are now faced with the difficult task of talking to their very young daughters about topics that have traditionally been reserved for preteens and teenagers. Mothers are often unsure about how to approach the topic with girls this young and how to relay the information in an age-appropriate way.
Some parents even wonder if they should be worried about the changes they are seeing in their daughter. Even in the medical community, breast development at age eight had been considered abnormal until a landmark study published in the April 1997 issue of the journal Pediatrics helped open the profession’s eyes to the growing prevalence of early-onset puberty. Conducted by researchers at the University of North Carolina at Chapel Hill, the study found that among 17,000 girls in North Carolina, almost half of the African American girls and 15% of Caucasian girls had begun breast development by age eight.
Sensing that many of her young patients and their mothers needed help discussing these important yet sensitive topics, Arnold decided to create an education program that would provide what she calls "a safe and comfortable environment where girls and their parents can ask frank questions." The need for such a program was especially great, she adds, because no other health care professionals in the Bay Area were providing this type of education at the time.
Facts and Feelings
Girls who attend the half-day Girltalk workshops must be accompanied by their mother or a mature female role model. "My workshops are very interactive and comprehensive," says Arnold, who speaks both English and Spanish. "They offer more information than girls typically receive at school. I want to encourage girls to respect and honor their bodies."
Arnold with three of her Girltalk workshop “graduates.” To date, over 400 girls have participated in the program.
She emphasizes that her workshop is not a sex education class but rather a forum where young girls can get honest and accurate information about the physical, emotional and physiological changes that occur during puberty. In addition to providing nuts-and-bolts information on everything from how the female body works to how to use feminine hygiene products, the workshops give girls and moms the opportunity to share their thoughts and feelings about becoming a woman and to celebrate this rite of passage.
Over her 13 years of facilitating the Girltalk program, Arnold has found that girls who have participated in her workshops tend to communicate more openly with their mothers, have a better understanding of their bodies and are better prepared to make decisions that will directly impact their health on their journey to womanhood.
"It isn’t every day that a young girl gets the opportunity to ask a nurse some of the more personal questions she may have about her body," Arnold says. "[Not having access to that information] is one of the main reasons why young girls tend to fear menstruation and puberty.
"I receive so many questions that start with 'Is it true that. . .?’" she continues. "Girls have often heard a lot of stories [about puberty] from other girls but not much about it from their parents. That’s where I step in to dispel myths and ensure the girls get accurate information presented in a fun and casual atmosphere."
Currently, Arnold covers the expenses of producing her workshop materials—such as age-appropriate media presentations—out of her own pocket, but she is working to secure corporate donors and other sources of funding. The typical registration fee for girls attending the workshop is $50, "but I offer this on a sliding scale and have never turned anyone away for lack of funds," she says. "Recently, I offered a free workshop for parents who donated a box of feminine hygiene products."
Arnold plans to send the products to villages in Africa where girls lack the resources needed to cope with menstruation. "Many young women in Africa have to miss several days of school or work each month because they don’t have access to feminine protection," she explains. For more information about Mary Arnold’s Girltalk program, contact her at (510) 595-3814, firstname.lastname@example.org.