Women's Reproductive Health

ISSN: 2329-3691 (Print) 2329-3713 (Online) Journal homepage: https://www.tandfonline.com/loi/uwrh20

Intergenerational Considerations for Educators

and Healthcare Providers Who Assist Girls and
Women Transitioning Through Menarche and
Menopause

Kimberly Field-Springer, Carol Reece & Deleasa Randall-Griffiths

To cite this article: Kimberly Field-Springer, Carol Reece & Deleasa Randall-Griffiths (2019)
Intergenerational Considerations for Educators and Healthcare Providers Who Assist Girls and
Women Transitioning Through Menarche and Menopause, Women's Reproductive Health, 6:2,
79-101, DOI: 10.1080/23293691.2019.1601904

To link to this article: https://doi.org/10.1080/23293691.2019.1601904

Published online: 04 Jun 2019.

Submit your article to this journal

Article views: 33

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=uwrh20
WOMEN’S REPRODUCTIVE HEALTH
2019, VOL. 6, NO. 2, 79–101
https://doi.org/10.1080/23293691.2019.1601904

Intergenerational Considerations for Educators and

Healthcare Providers Who Assist Girls and Women
Transitioning Through Menarche and Menopause
Kimberly Field-Springer, Carol Reece, and Deleasa Randall-Griffiths
Department of Communication, Berry College, Mount Berry, GA, USA

ABSTRACT ARTICLE HISTORY

The present study, informed by multigenerational communication, Received 17 August 2017
was designed to produce practical implications for mothers, teachers, Revised 25 October 2018
and healthcare providers who prepare adolescent girls for menarche Accepted 4 January 2019
and women for menopause. Our findings revealed four themes: (1)
KEYWORDS
too little or too much media information; (2) preparation for menar- reproductive health; sex
che at and away from home; (3) mothers talk to daughters, fathers education; menopause;
talk to sons; and (4) am I normal? An examination into how three menstruation; multigener-
generations of women talk about reproductive health within their ational communication;
immediate familial context(s) offers insight for mothers, teachers, narrative analysis
and healthcare providers who educate and prepare women for tran-
sitions that shape self-confidence, perceptions of themselves in soci-
ety, and their development of negative and/or positive beliefs about
reproductive health.

Intergenerational approaches to understanding communication across the lifespan of

women assume that familial scripts manifest and shape recurrent narratives passed
down to the next generation (Miller-Day, 2004). These familial scripts shape positive
and negative perceptions of girls and women that inform cultural understandings of
women’s reproductive health transitions. Studies have focused on the amount and types
of information transmitted intergenerationally, as well as the influence this information
has had on values, beliefs, and attitudes toward reproductive health. The present study
focused specifically on multigenerational communication among grandmothers, daugh-
ters, and granddaughters about the onset of menarche and the transition
into menopause.
Menarche is defined as the first menstrual period. Studies have suggested that when
mothers prepare their daughters for menstruation prior to menarche, their daughters
exhibit more positive attitudes toward menstruation (Chang, Hayter, & Wu, 2010;
Marv
an & Molina-Abolnik, 2012; Porter, 2006; Rembeck, M€ oller, & Gunnarsson, 2006).
During the time of menarche, Rembeck et al. (2006) found that 79.1% of girls had been
told about menstruation by their mothers, and 83.1% felt that they could talk to their
mother about menstruation. Communication between mother and daughter prior to
and during the time of menarche creates familial patterns of discourse that influence

CONTACT Kimberly Field-Springer kfieldspringer@berry.edu Department of Communication, Berry College, 2277

Martha Berry Hwy. NW, Mount Berry, GA 30149 USA.
ß 2019 The Society for Menstrual Cycle Research
80 K. FIELD-SPRINGER ET AL.

cultural and gendered talk about menstruation and other aspects of reproductive health.
When it is time to make an important health decision, mothers continue to be the most
influential source to whom adolescents turn for advice (Chao, Slezak, Coleman, &
Jacobsen, 2009; Roberts, Gerrard, Reimer, & Gibbons, 2010; Seibold, 2011; Warren-
Jeanpiere, Miller, & Warren, 2010). For example, mothers’ screening history and atti-
tude toward Pap tests and the HPV vaccine was found to have had some influence on
adolescents’ decisions to engage in preventive reproductive health behaviors (Chao
et al., 2009; Roberts et al., 2010), and African American adolescents were more likely to
seek reproductive health care if their mothers had recommended preventive care
(Warren-Jeanpiere et al., 2010).
Mothers do share stories and information with their daughters about menstruation and
reproductive health. Yet young women also gather information about sexual and repro-
ductive health concerns from other sources. According to Seibold (2011), 78% of women
between the ages of 18 and 24 identified peers as a source of sexual and reproductive
health information, followed by media at 72%, mothers at 62%, and health professionals
at 62%. Orenstein (2016, p. 34) referred to media as a “super peer” to which girls turn
for behavioral scripts about sexual and reproductive health norms. According to Marv
an
and Molina-Abolnik (2012), young women who rely on media for reproductive health
information perceive menarche as a hygiene crisis. Given that results about where young
women turn for reproductive health information are mixed, if mothers can intervene
early, they have an opportunity to shape their daughter’s perception of menstruation posi-
tively through supportive mother–daughter communication (Lee, 2008). Given that most
girls believe that they could talk to their mothers about menstruation (Rembeck et al.,
2006), mother–daughter communication before, during, and after menarche is crucial to a
girl’s positive perspective of reproductive health milestones. Conversations reinforce fam-
ily values and beliefs about the reproductive health experiences that can impact women’s
interactions throughout their lifespan and across generations.
Similar to conversations about menarche, the way women talk about menopause
reveals insights into family attitudes and value systems. Menopause can be induced by
surgery or chemotherapy; sometimes involves transitional stages accompanied by vari-
ous symptoms including vaginal dryness, hot flashes, and night sweats; and is clinically
diagnosed as 12 months after the last menstrual cycle (Nelson, Taylor, & Weatherall,
2008). During the menopausal transition, some women rely on familial scripts from
their mother or other female relatives to compare their own personal experiences of
menopause with a desire to know when menopause will “end” (Dillaway, 2007;
Dillaway & Burton, 2011). For instance, 69% of women interviewed in the midwestern
U.S. included their mother’s menopause experience when they narrated their own
experience of menopause even when her experiences were physiologically different from
their own (Dillaway, 2007). Utz (2011) found that baby boomers born in the 1950s (i.e.,
the daughter cohort in a mother–daughter paired study) desired to remain in control of
bodily transitions during menopause. As the definition of menopause has become more
medicalized, the early baby boomer generation perceived it as a negative experience of
aging. Utz (2011, p. 149) reported that “the most common strategy that the daughters
used to maintain control over their perimenopausal bodies was to use pharmaceutically
derived intervention such as HRT” in an effort to delay the process of aging. Women’s
 WOMEN’S REPRODUCTIVE HEALTH 81

decisions regarding reproductive health often connect to the stories they hear and the
experiences they witness.
Mothers are also influenced by their adult daughters when it is time to make an
important health decision. According to Mosavel, Simon, and Van Stade (2006), who
surveyed mothers and daughters in a South African community, 93% of mothers said
they would listen to medical advice from their adult daughters. Mothers living in
California who identified as Mexican, Mexican American, Filipina, or Filipina American
said that they would obtain a mammography and other health screenings if
adult daughters insisted (Washington, Burke, Joseph, Guerra, & Pasick, 2009). Thus
mother–daughter communication is an important determinant of health attitudes and
behaviors, especially during menopause, and, as such, our investigation into meanings
created from these relationships may provide additional insight and understanding of
reproductive health milestones, decisions, and behaviors.
Grandmothers’, daughters’, and granddaughters’ narratives of menarche and meno-
pause cannot be separated from sociocultural perceptions of sexuality, body image, and
the biomedicalization of reproductive health that labels women’s transitions in disease
frameworks (Chang et al., 2010; Hasson, 2016; Hyde, Nee, Drennan, Butler, & Howlett,
2011; Jackson & Falmagne, 2013; Kissling, 2013; Lee, 2008). According to Lee (1994, p.
346), “menarche is an important time when young women become inserted and insert
themselves into the dominant patterns of sexuality.” Mothers have linked menarche to
sexuality, and communication of this link reinforces a dominant script that pressures
girls to understand how their bodies differ from boys’ (Chang et al., 2010). These com-
mon messages are also communicated to schoolgirls by teachers. According to Diorio
and Munro (2000, p. 352), messages focused on sexuality are “fixated on the reproduct-
ive implications of puberty” and, as a result, “pay little attention to helping girls acquire
confidence in their changing bodies during this largely non-reproductive stage of their
lives.” Girls are then taught to self-surveil their menstruating bodies for fluids and
odors, which reinforces master narratives of “menstrual shame” if they fail to abide by
dominant social norms and media messages to remain “clean” (Calogero & Pina, 2011;
Diorio & Munro, 2000; Fingerson, 2005; Jackson & Falmagne, 2013; Lee, 1994; Lee,
2009; Martin, 2001; Moore, 1995). When they interviewed women between the ages of
18 and 21 about their menarcheal experience, Jackson and Falmagne (2013) found four
themes: (1) uncertainties regarding what it means to become a woman, (2) how to con-
ceal menstruation, (3) employing language that distanced the body from self, and (4)
solidarity through a community of suffering. Fingerson (2005) explored how girls inter-
pret their experiences of menstruation from an embodied perspective; the stories girls
told both reinforced and challenged “dominant gendered expectations” (p. 107). For
example, girls constructed both positive and negative meanings; they wanted to control
their bodies, and yet they embraced their monthly menses as a healthy bodily function.
Furthermore, Johnston-Robledo et al. (2007) found that women who engage in high lev-
els of self-objectification also experience reproductive shame and report negative atti-
tudes toward menstruation. Both Johnston-Robledo et al. (2007) and Sveinsd
ottir (2017)
argued that healthcare providers ought to discuss body concerns and self-image in prep-
aration for menstruation in an effort to mitigate negative attitudes toward aspects of
reproductive health.
82 K. FIELD-SPRINGER ET AL.

Menstruation is an embodied experience connected to the social fabric of women’s

lives, and communication about menstruation includes both negative and positive sto-
ries passed down from generation to generation. Both Lee (2008) and Teitelman (2004)
found positive and celebratory narratives passed down through mother–daughter con-
versations. Taghva (2010) discovered that daughters who had mothers trained to under-
stand and communicate about biopsychosocial changes (e.g., hair, body weight, acne,
identity, sexuality, relationships) reported more positive attitudes toward menstruation
and became more resourceful when seeking information from mothers, teachers, media,
and school counselors. Even though generational narratives reflect remnants of domin-
ant scripts, positive meanings communicated by emotionally available mothers lead to
more positive perceptions of menstruation (Lee, 2008; Marv
an & Molina-Abolnik, 2012;
Obono, 2012; Taghva, 2010; Teitelman, 2004).
Mothers influence their daughters’ perceptions as they communicate personal experi-
ences of menopause, and when these experiences are negative, their daughters may
engage in self-surveillance, shame, and guilt (Dillaway, 2007; Dillaway & Burton, 2011;
Rubinstein & Foster, 2013). Personal experiences of this transitional stage have been
described as uncertain and laden with psychological ambivalence as women begin to
navigate how to live with symptoms such as vaginal dryness, hot flashes, and night
sweats (Dillaway & Burton, 2011; Field-Springer, 2012; Shore, 1999). Until the 1990s,
menopause was viewed by most as a medical event to be treated by hormone therapy
(Cimons, 2006). But in 2002 a large U.S. National Institutes of Health study known as
the Women’s Health Initiative concluded that synthetic estrogen increased risks for
breast cancer, heart attack, blood clots, and stroke, which outweighed any benefits
(Gullette, 2003). Dominant, biomedical discourse, specifically meanings that construct
menopause as a disease, reinforce medical compliance and the use of treatments to “fix”
the body rather than to manage symptoms of menopause (Dillaway, 2008; Dillaway &
Burton, 2011; Field-Springer, Randall-Griffiths, & Reece, 2018; Murtagh & Hepworth,
2005). Biomedical definitions also lead women to perceive their lower sex drive as
“unhealthy” (Hyde et al., 2011), and partners of women who are experiencing meno-
pause also frame the transition as a disease (Dillaway, 2008). Thus the biomedical model
limits the meaning of menopause and the ways women understand, cope with, and treat
signs and symptoms of menopause as part of the process of aging.
The present study of multigenerational talk among grandmothers, daughters, and
granddaughters offers insight into how solicited and unsolicited advice from mothers,
teachers, and healthcare providers affected their preparation for the reproductive health
milestones of menarche and menopause. Previous multigenerational studies with grand-
mothers, daughters, and granddaughters focused on communication about maternal
familial contexts and/or menstruation (Miller-Day, 2004; Mosavel, Simon, & Van Stade,
2006; Porter, 2006). Research regarding preparation for menarche in schools has indi-
cated that the information provided is often too little and too late (Lesta, Lazarus, &
Ess
en, 2008). Healthcare practitioners also serve an important role in educating girls
and women about menstruation and menopause and can affect their health, body
image, and well-being (Sveinsd
ottir, 2017; Theroux, 2010). In the present study we ana-
lyzed meanings rooted within the stories three generations of women told each other
that simultaneously reveal the advice given from mothers, teachers, and healthcare
 WOMEN’S REPRODUCTIVE HEALTH 83

providers during girls’ and women’s menarcheal and menopausal transitions. With this
in mind, we were guided by three research questions concerning reproductive health
sense-making:
RQ1: What can we learn from conversations among three generations of women about
advice they received from their mothers that informed their education in preparation for
reproductive health milestones?

RQ2: What can we learn from conversations among three generations of women about
advice they received from their teachers that informed their education in preparation for
reproductive health milestones?

RQ3: What can we learn from conversations among three generations of women about
advice they received from their healthcare providers that informed their education in
preparation for reproductive health milestones?

Method
Participants
Thirty participants made up 10 generational triads (one grandmother, one daughter,
and one granddaughter). They ranged in age from 18 to 83. Eight of the 10 triads were
recruited through undergraduate courses at a private university located in the midwest-
ern United States, and two triads were recruited by word-of-mouth solicitation. We
asked college students enrolled in our classes, as well as granddaughters in our own
social circles, if their mother and grandmother would be interested in participating in a
study where they told stories of their menopause and menarche experiences. The study
was approved by our institution’s Human Subjects Review Board prior to data collec-
tion, and each triad received $50.00 in compensation. Information reported here is a
part of a larger study. In a previous article we reported on the personal stories the
grandmothers, daughters, and granddaughters shared with each other when experienc-
ing menarche and menopause (Field-Springer et al., 2018).
We labeled the three generations according to their relationship to one another:
grandmothers (G1) ranged in age from 67 to 83, daughters (G2) ranged in age from 44
to 57, and granddaughters (G3) ranged in age from 18 to 22. Focus on these gener-
ational roles give insights into “transmission of information, values, and beliefs up and
down the generations” (Porter & Gustafson, 2012, p. 22). Two participants identified as
Asian American, and the others identified as White. Seven had earned a college degree,
and 10 were in the process of earning a college degree. In five of the 10 triads, one
member of the family was a healthcare professional. The average age at menarche for
all participants was 13, with a range of 10 to 17 years. The average age when 18 partici-
pants began to experience symptoms of menopause was 46, with a range of 39 to
59 years. Of the 20 participants who were in the process of perimenopause, two indi-
cated that they had experienced no symptoms, and four indicated that they experienced
symptoms abruptly due to full or partial hysterectomies. All participants in this study
were given pseudonyms.
84 K. FIELD-SPRINGER ET AL.

Procedure
The interview protocol was designed to meet the goals of multigenerational research
and narrative interviewing techniques (see Field-Springer et al., 2018). To promote
storytelling, the interview protocol elicited responses from three main categories: (1)
accounts of lived experiences during reproductive health milestones; (2) negative and/or
positive experiences of these milestones; and (3) the participants’ communication with
their mothers, teachers, and healthcare providers before, during, and following repro-
ductive health transitions. Here we concentrate on participants’ responses from the third
main category. For example, we asked, “Did you receive prior education formally or
informally about menstruation?,” followed by a probe about advice or decisions they
made that were informed by healthcare providers, teachers, family members, peers, or
media. Interviewers also asked the same question about menopause. Additional ques-
tions included how granddaughter-daughter-grandmother’s advice influenced their
health behaviors in preparation for menarche and menopause. We also asked what
information they believed should be communicated by teachers and healthcare pro-
viders. Individual and reflexive descriptions of reproductive health experiences were
analyzed to understand how three generations of women recount conversations with
their mothers, teachers, and healthcare providers. At the beginning of each interview
session with the triad, informed consent was requested, and a description of the study
was read aloud. All members of a generational triad were required to be present at the
time of the interview. Interviews were conducted at private site locations convenient to
each triad. Interviews lasted 60–90 minutes and were digitally recorded and tran-
scribed verbatim.

Analysis
Narrative analysis provides insight into the co-constructed meanings three generations
of women created about their menstruation and menopause experiences. Storytelling is
a practice that allows for the organizing of often chaotic events into patterns that help
people make sense of the events (Harter, 2012), while simultaneously allowing for the
exploration of meanings that emerge from self, others, and society (Ellis & Berger, 2002;
Mead, 1934/1967; Pennebaker, 2000). Meanings were examined discursively in relation
to dominant societal discourses and reflexive accounts influenced by sociocultural, gen-
dered norms with regard to power (Kalcik, 1975; Mead, 1934/1967; Scott, 1991; Torres,
1992). Discourse was analyzed based on three types of narrative constructs: master,
counter, and negotiated. Meanings from the stories women shared with each other were
located among these master, counter, and negotiated narratives. Following in the trad-
ition of poststructuralist theory, scripted meanings are narratives that uphold a grand or
master narrative, and unscripted meanings are those that counter master narratives
(Lyotard, 1984). Master narratives, also referred to as dominant scripts, are stories that
reinforce conventional meanings often imposed on the self and/or others (Lyotard,
1984). Counter narratives are stories that resist conventions and enable the self and
others to create their own meaning (Nelson, 2001). Negotiated narratives are a product
of both master and counter narratives. These stories simultaneously resist and challenge
 WOMEN’S REPRODUCTIVE HEALTH 85

conventions; for example, stories of women who critique standards of beauty but dye
their own hair to remove signs of aging are negotiated narratives (Field-Springer, 2012).
We analyzed data using a multilayered reading process. We read and interpreted dis-
course for both individual accounts of reproductive health experiences and reflexive
accounts of reproductive health experiences among all women. This approach was
inspired by the importance of attending to the reflexive, intergenerational accounts
among three generations of women who regularly tend to (re)story each other’s lives. In
addition to analyzing data from reflexive accounts using theoretical constructs devel-
oped by Mead (1934/1967) and narrative philosophers, we also attended to women’s
discourse that was informed from sociocultural influences concerning femininity.
Societal discourses were read and analyzed based on three divergent types of narratives:
master, counter, and negotiated. The first reading was open-coded (Charmaz, 2014).
The second reading included our coding scheme, which used Mead’s ideas on symbolic
interactionalism combined and categorized with either master, counter, and negotiated
narratives. These coding schemes included: (1) personal reflections that contributed to
one’s unique lived experience and (2) reflexive accounts among grandmothers, daugh-
ters, and granddaughters. Each of these coding schemes were further categorized into
master, counter, or negotiated narratives. The final readings aimed at refining overarch-
ing themes. Out of this process emerged four themes informed by conversations among
multigenerational family members who discussed reproductive health transitions: (1)
too little or too much media information; (2) preparation for menarche at and away
from home; (3) mothers talk to daughters, fathers talk to sons; and (4) am I normal?

Results
Too little or too much media information
This theme reveals the collective, reflexive accounts among three generations of women
who discussed media representations of women’s sexual and reproductive health both
past and present—a topic that was once silenced but is now recognized by the women
in our study as a commodity. Grandmothers in our study discussed how the media
silenced women’s reproductive and sexual health concerns back in their day. Jean (G1)
said, “Mainstream media did not talk about any of it and now they’re advertising
Viagra for men on TV,” and Norma (G1) explained how she lacked the opportunity to
access any information about women’s reproductive and sexual health when she was
growing up. Grandmothers think there is now too much information in mainstream
media. Kathryn (G1) said, “There’s too much information put on TV,” and Louise (G2)
quickly followed with, “Yeah, but I don’t know if that is a bad thing, maybe that is
where some people get their information.” The daughters in our study were pragmatic
in their response to media messages and suggested that some of the information might
not be all that bad, especially when it concerns medications for common symptoms
(e.g., cramps, headaches, mood swings, bloating). Tracy (G2) reminisced about how it
used to be and explained that “These ads show what happens behind closed bathroom
doors offering a space for conversation. Before, women’s experiences of menstruation
used to be a secret often mocked by others.” Anne (G1) said, “I have difficulty with
Kotex commercials on TV. I feel that girls are too young and I’m quite upset about
86 K. FIELD-SPRINGER ET AL.

that.” Another grandmother, Jean (G1), said, “Media in America is perfection when it
comes to women. And that part of our society is not true to all of us. It puts pressure
where you don’t need it.” Information about women’s reproductive and sexual health
was a taboo topic rarely displayed on television or talked about in the home when the
grandmothers were young. Yet participants in our study mentioned that sexualized and/
or commoditized images of young women in contemporary media are now inescapable.
Jean’s (G1) granddaughter, Ember (G3), said, “Even the tampon commercials have
perfect women running, skipping, and playing sports. Be happy. It’s kind of ridiculous.
Now it’s become a market for the cooler brand.” Jamie (G3) said, “There are tampon
commercials all the time on TV. There are so many brands, so many styles, and so
many sizes.” Her grandmother, Barb (G1) agreed, “They overdid it.” In another triad,
Kate (G2) said that they “enjoy making fun of the tampon commercials.” Daphne (G3)
replied, “Yeah, like I’m going to wear white pants” [a reference to the appearance of
models in the commercials]. Daphne’s (G3) comment, although critical of messages
about the pressure for women to be perfect even during menstruation, reinforces the
notions of fear, self-surveillance, and menstrual shame. Hart (G3), a granddaughter in
another triad, cynically mocked the tagline in a tampon commercial, “Have a Happy
Period.” Bev (G1) followed with, “I want to throw an ax through the TV when I see
that one.” Hart (G3) continued:
I think everybody’s experience is different, but I think overall a lot of people don’t have a
very positive experience with it. And so it may put something in the back of everybody’s
mind that, oh, it is no big deal. And then when someone complains about it, then it’s like
well you’re just complaining about it, just stop, or something like that.
Hart (G3), Ember (G3), and Jamie (G3) keenly questioned whose story is being told,
implying that media create unrealistic representations of the “perfect” woman that fall
short of their personal experiences of menstruation. Media representations of sexual
and reproductive health simply did not exist in the past, according to grandmothers
(G1). Both granddaughters’ (G3) and grandmothers’ (G1) responses contained elements
of counter narratives critical of the commoditization of menstruation in the feminine
hygiene product commercials that portray unrealistic models who appear perfect during
their menses.
When they discussed menopause, grandmothers and their daughters shared stories
about how the topic itself is no longer silenced in popular discourse or mainstream
media. Kathryn (G1) recounted a positive experience with friends after they had
attended a play about menopause:
Well, there was a live play. There were about 10 of us women from church who went to
see it. It was called Church Basement Ladies and they dealt with a lot of things like the
dinners they had at church but they had one segment that was about women going
through menopause. One woman actually tried to crawl through the chest freezer because
she was having hot flashes. I mean, it was hilarious how they did it. But it made you sit
and think about—oh my gosh—everything they are saying is true. But they did it in such a
comical way that would have been taboo 50 years ago. Nobody would’ve done anything
like that.
Louise (G2) agreed, “I don’t think it’s a taboo anymore, I don’t think with as much
that’s on TV. There’s this commercial that runs all the time about rejuvenation,
 WOMEN’S REPRODUCTIVE HEALTH 87

hormone replacement therapy, and the one lady even talks about having no interest in
her husband anymore.” Several of the women also discussed how access to education
and information online helped them to decide whether treatment options advertised in
mainstream media were right for them. Jean (G1) directed her attention toward her
granddaughter and groaned, “One thing that you have that we did not have is the
Internet.” In another triad, Wanda (G2) said, “I mean with anything nowadays, there is
so much information. I mean with the Internet, you can Google anything.” Norma (G1)
replied, “We didn’t have that opportunity.” Wanda (G2) insisted, “I think it has helped
with knowing your options and treatment plans.” In another triad, Bev (G1) com-
mented, “I mean, you can go to Web MD and check your symptoms.” Her granddaugh-
ter, Hart (G3) cautioned, “That’s sometimes the worst thing to do. But information is
nice after an office visit with a diagnosis. You can access information, ask questions,
and join forums where people talk about similar issues.” Grandmothers and daughters
expressed their enthusiasm for accessing online information about menopause, whereas
granddaughter Hart advised her grandmother always to consult a healthcare profes-
sional prior to carrying out medical directives read online.

Preparation for menarche at and away from home

This theme explores how grandmothers, daughters, and granddaughters talked about
their experiences with sex and reproductive health education classes in school and how
this information was reinforced again at home. All except for one of the grandmothers
(G1) in our study mentioned not having had any sex education in school. Their daugh-
ters (G2) remembered being separated from the boys in 5th grade and either watching
a film or hearing a lecture by a teacher about sexual and reproductive health. The
granddaughters (G3) were first introduced to sex education in a 6th-grade general
health class or as part of a biology class. According to the Guttmacher Institute (2017),
only 24 U.S. states and the District of Columbia mandate sex education in schools. All
of the triads in our sample except for one were from a state that mandates
sex education.
Reflective of the times, grandmothers said that nothing was discussed in school,
whereas granddaughters said that their education lacked context, which made it difficult
to connect what they learned to their lived experiences. Kathryn (G1) said, “There was
nothing in the schools, not back when I was in school.” Louise (G2) chimed in, “Mine
was in school when they put the girls in one room and boys in the other.” Henley (G3)
recounted her experience:
I don’t really remember learning specifically about the menstrual cycle in school. I had a
health class in 6th grade and once again in 7th. We had it in high school too, but it was
more about nutrition and drugs. I know we learned about basically everything about the
body but not specifically the girl’s body.
Another granddaughter, Valerie (G3), said, “My health teacher passed out pads and
tampons. I have no idea why but he just passed them out to us and didn’t go over any-
thing.” Her mother, Teresa (G2), said, “Oh, I assumed that they did something.” Ember
(G3), a participant from the state that does not mandate sex education, shared:
88 K. FIELD-SPRINGER ET AL.

To be honest, I think I’m going to be a surprising answer because I didn’t receive any
formal education at all. I mean, in the state of Indiana, I mean we get taught some things.
But we’re taught abstinence only. They never addressed, I mean, maybe a little bit. But I
can’t remember my teachers ever talking about girls going through periods and what you
would need to know.
Her grandmother, Jean (G1), agreed, “Yeah, it is political, and it’s crazy but it is.
Reproduction should not be political.” The absence of discussion of the topic of men-
struation during sex education was implicit in the participants’ recollections of learning
about reproductive health in school, regardless of their generation. Participants shared
narratives about the invisibility of, or diversion from talking about, menstruation in
schools, which reinforced a master narrative that implies that these bodily changes are
unimportant.
Granddaughters found their introduction to sex education and reproductive health
information in schools disappointing, especially the teachers’ tacit avoidance of follow-
up discussions with them. This compelled them to initiate conversations with their
mothers at home. Unlike the grandmothers, who seldom discussed reproductive health
with their mothers, their granddaughters desired to talk about reproductive health at
home with their mothers prompted by the talk they received at school. Amy (G3)
recalled, “I never really got information, like learning the talk in like 6th grade. They
were so vague about it. I mean it was just another health class. We didn’t take the
teacher seriously so I honestly don’t remember any of it.” Her mother Tracy (G2), a
healthcare provider, interrupted, “So when I realized she was still clueless, I got out my
books and diagrams.” Amy (G3) said, “The only information I knew was what I learned
from my mom, not from the talk. All of my information came from my mom because
she is my most reliable source. Because if you try to look on the Internet, everything is
like horrible.” Tracy (G2) replied, “I don’t think information is getting imparted to
young girls about periods, ovulation, and when you can get pregnant or how you get
pregnant. She was absolutely clueless. You really have to make the information idiot-
proof. It’s not truly directive.” Amy (G3) agreed, “It needs to be less secretive and more
directive.” The daughters and granddaughters in our study constructed counter narra-
tives by resisting the silencing of discussion about sexual and reproductive health mile-
stones in the home.
Several of the daughters and granddaughters discussed the use of popular culture
books, including The Care and Keeping of You: The Body Book for Girls (Schaefer,
1998),1 which offers a realistic take on the changes that occur in a girl’s body, and The
Red Tent (Diamant, 2010), a book with celebratory narratives that honor menarche.
Henley (G3) said, “I don’t remember what happened at school.” Her mother Louise
(G2) shared:
I don’t know either; I know we were totally prepared for it. We had bought the American
Girl Book and I started reading it to both of the girls probably at least a year before I
thought there was any inkling that they were going to start so we could just talk about
everything. It goes through shaving, wearing deodorant, and acne. I would carefully read
one section at a time because both of you wanted to skip to the end and I was like nope
let us read it together all at once. Then, we got to the end and I don’t think it was very

1
The Care and Keeping of You: The Body Book for Girls is part of the American Girl Doll Series.
 WOMEN’S REPRODUCTIVE HEALTH 89

traumatic. I said if and when it happens just come talk to me and we’ll take care of
anything that needs to be taken care of.
Renee (G2) also read the book to her daughter Reece (G3). Reece (G3) shared, “I still
have that book. It was very informative and showed pictures and diagrams.” Another
daughter, Rachel (G2), read the book to her daughter Sophia (G3) because she remem-
bered that her first period was not positive, and she wanted her daughter to have a
positive experience. Sophia (G3) said, “It’s a book about puberty and changes in girls
and it is for young girls to prepare.” Sophia (G3) said that she would someday share
the book with her daughter because she does not want her daughter to have a negative
experience like her mother and grandmother had. When Kate (G2) was asked if she
would have done anything differently to prepare her daughter for menarche, she replied,
“I read the book, The Red Tent. I did want to throw a big party for Daphne (G3). I did
want her first period to be a joyous celebration rather than a total burden.” Daphne
(G3) mumbled, “You didn’t do that.” “Sorry, I dropped the ball. Yeah, I wasn’t even
there for it,” Kate (G2) said. Daphne (G3) laughed, “I know, nobody was except for a
bunch of men.” At the time of her menarche, Daphne (G3) was camping with some
male family members. In another triad, Natalie (G2) said she routinely talked to her
daughter at home about what she was learning in school to prepare her for menarche.
The comments from Amy, Sophia, Reece, and Henley convey that these granddaughters
who read and talked about reproductive health with their mothers were better prepared
for and more optimistic about menarche than the earlier generations.

Mothers talk to daughters, fathers talk to sons

This theme examines discussions among grandmothers, daughters, and granddaughters
who advocate educating and instilling empathy into the lessons parents teach both sons
and daughters at school and home so that they will understand each other’s sexual and
reproductive health. Our participants wondered why boys and men do not understand
more about reproductive health. Eloise (G1) ruminated, “In our society, mothers talk to
their daughters, the fathers talk to their sons. Where does the responsibility lie in these
discussions? Who is socially responsible for educating our sons?”
Daughters’ experience of sex and reproductive health education in school occurred in
separate, single-sexed classrooms. Grandmothers, daughters, and granddaughters, in
reflection, recognized the practice of separating girls and boys into different classrooms
as valuable in some regards, yet detrimental for boys and girls who lack the knowledge
to understand and empathize with what each other is experiencing. Hart (G3) and Amy
(G3) believed that it is easier to talk about certain health problems they face together as
girls without the pressure of boys acting inappropriately. Yet following separation, sev-
eral of the daughters felt pressured to explain to the boys what they talked about during
their private class session. Louise (G2) said, “The boys wanted to know what movie we
watched because they watched King Kong.” Mary (G2) said, “Boys should be hearing a
lot of what the girls are going through.” Ember (G3), her daughter, replied, “Maybe, if
there is education for boys to be more understanding that might help.” Jean (G1),
Ember’s grandmother, concluded, “Even in high school, there probably needs to be
more [coed] discussion.” The grandmothers, daughters, and granddaughters in our
90 K. FIELD-SPRINGER ET AL.

study promoted the implementation of a curriculum that offers an open, respected, and
safe space for both single-sex and coed discussions.
Grandmothers and their daughters also mentioned that, if mothers talked to their
sons about reproductive health, men might become more empathetic toward women
during reproductive health transitions. Eloise (G1) said, “I think it would make a world
of a difference if mothers would talk to their sons.” Another grandmother, Kathryn
(G1), said:
It starts in the home. I think if boys are only educated in the schools, then you are going
to have boys making fun of it. Whereas, if their mothers would sit their sons down and
say this doesn’t deal with your body, but you’re getting of age now where girls are dealing
with this—so you should have this knowledge of what is going on in their world.
As unorthodox as this may seem, the grandmothers and their daughters believed
that, if mothers talk to their sons, stereotypes and disparaging comments to women by
men might decline. Kathryn (G1) said, “I worked in the sheriff’s department with a lot
of men and if a woman stood up to them, they would say, ‘man she must be on the rag
today.’” In another triad, Kate (G2) said, “Men will use your period to justify or accuse
you of being too emotional. Women couldn’t possibly be in charge of big decisions
because she might be having her period. We could never be president because … ”
Meredith (G1) cut her off: “We’d push the button.” “Yeah,” Kate (G2) said. Meredith
(G1) replied, “I think men define us in ways that we wouldn’t define ourselves.”
Grandmothers and their daughters also mentioned that they had to educate their hus-
bands about women’s reproductive health milestones. Louise (G2) said, “When I got
married there would be times where I would make a comment about something and
my husband would make a comment. I would say why would you even say that? I think
I educated him more on a woman’s cycle and getting pregnant. I mean he didn’t have a
clue.” Jean (G1) said, “I don’t think men really understand what a woman is going
through. If you’re sweating and hot, they can obviously see that. But the change you go
through emotionally, I don’t think men are prepared for that at all.” Participants in our
study were inclined to believe that if more mothers talked to their sons and fathers
talked to their daughters, a cultural shift could result where men and women were
more understanding of one another’s bodily and emotional changes as well as the pres-
sures to conform to societal expectations during reproductive health milestones.

Am I normal?
This theme explores how grandmothers, daughters, and granddaughters talk about and
employ the word “normal” when they encounter healthcare professionals to solicit
advice and reproductive health services. In biomedical narratives of menstruation as
“normal,” meaning is limited by imposing medical terms onto unique, lived experiences
of menarche, which leads girls to accept menarche as a medical experience rather than
a personal or developmental one. Medical guidelines often define menopause as the ces-
sation of regular periods, which is an inadequate description, because, in reality, wom-
en’s experiences of menstruation vary throughout their lifetime.
When participants were asked if they had visited a healthcare provider in preparation
for menarche, the grandmothers explained that, in their youth, doctors’ visits were a
 WOMEN’S REPRODUCTIVE HEALTH 91

luxury for those who had insurance or could afford it. Meredith (G1) said, “Well, grow-
ing up, health care was so different when I was a kid. I mean not everybody had insur-
ance. Doctors’ visits were for when you were dying.” Daphne (G3) interjected, “I go to
the doctor all the time.” Meredith (G1) continued, “So, it’s different nowadays.” In
another triad, Becky (G2) asked her mother, “Don’t you think health has changed
because of insurance? I mean it just wasn’t feasible before.” Barb (G1) responded, “I
was single. I didn’t have insurance. I didn’t have medical care that is available today.”
In contrast, all of the granddaughters (G3) in our study except one have visited a
healthcare provider for routine reproductive health care. The American College of
Obstetricians and Gynecologists (2015) has recommended that girls schedule their first
visit between the ages of 13 and 15 when they receive a general physical exam but not a
pelvic exam. Many of the granddaughters’ motivation for visiting a healthcare provider
was to ask if they were “normal,” and, consistent with a recent trend, 4 of the 10 men-
tioned that they had requested a prescription for oral contraceptives to regulate acne
rather than their menstrual cycle. Ember (G3) explained:
I think it would be nice for doctors to explain why things are normal. I remember my first
gynecologist visit. She gave me a breast exam. She was like, ‘Whoa,’ those are lumpy but
that’s normal for your age. It’s normal. And I just don’t remember why it was normal.
Maria’s (G3) pediatrician told her when she developed breast buds that her period
would start soon after. Her pediatrician also said that she would stop growing. Wanda
(G2), her mother, explained, “Maria’s period started soon after but she continues to
grow.” In another triad, Kate (G2) said that medical information helps by offering a
guideline for what to expect. Meredith (G1) said, “Sometimes, it helps you feel like
you’re normal. I would flow so heavy. Am I the only one that does this? But then, you
find out from your doctor that this is the reason it’s happening. You know you’re not a
monster or strange.” Daphne’s (G3) doctor asked her mother to step out of the room
before asking several questions, including questions regarding sexual activity. Daphne
(G3) said, “It made me feel open and able to tell her stuff.” Kate (G2) responded, “I
would think that doctors should be asking those types of questions around developmen-
tal ages to children.” Participants in our study relied on the term normal to alleviate
their uncertainty during reproductive health transitions.
The notion of normalcy also emerged in grandmothers’ and daughters’ discussions
about their personal experiences with healthcare providers concerning menopause and
aging. Menopause, however, cannot be medically defined with a definitive cessation
point (Dillaway & Burton, 2011), nor should it necessarily be medically controlled with
hormone therapies because of the risks associated with synthetic estrogen (Gullette,
2003). Rachel (G2) said she was experiencing agitation and tiredness when her gyne-
cologist made the connection to menopause. Rachel (G2) even asked at one point,
“How would I know for sure that I am experiencing menopause because I hadn’t had
some of the common symptoms like hot flashes?” Teresa (G2) was prescribed antide-
pressants during perimenopause. She said, “They [healthcare providers] really don’t help
you. You kind of have to do it yourself with a support group, like family.” Louise’s
(G2) doctor, after having charted a pattern of heavy bleeding for a year, discussed cry-
oablation, a treatment option to remove the uterine lining to eliminate menstruation.
Louise (G2) decided against the procedure because it is an elective surgery that comes
92 K. FIELD-SPRINGER ET AL.

with risks and was not a medical necessity. Louise’s mother, Kathryn (G1), had a dila-
tion and curettage (D&C) procedure to scrape the uterine lining, which stopped her
heavy bleeding. Norma (G1) had two D&Cs, one in 1984 and another in 1988. Norma
(G1) said, “I had no idea. I was 44 so I was thinking I’m too young to be starting
menopause. I just relied on what he [doctor] was telling me.” After the second D&C,
the doctor prescribed hormone therapy that she took for 14 years until she began to
develop lumps on her breast. Her daughter, Wanda (G2), refused to take estrogen for
an extensive amount of time. Several of the grandmothers (G1) mentioned feeling
uncertain during their perimenopausal experiences and, therefore, complied with their
doctors’ orders to treat symptoms. Many of the daughters (G2), on the contrary, advo-
cated for a treatment option based on current knowledge about the risks associated
with therapies and procedures as opposed to simply following doctors’ orders.
Grandmothers, daughters, and granddaughters’ discussions, through reflexive conver-
sations with each other, presented a cultural shift about how women conceptualize and
participate in the patient–provider relationship. Becky (G2) said, “I know when I was
having symptoms, probably mid-40s, the doctor wanted to put me on estrogen. Well,
articles had come out that it was linked to breast cancer. I said, ‘Well, I don’t want to
do that.’” Barb (G1), her mother, took estrogen because she “didn’t think much of it
but to accept doctor’s order.” Jean (G1) mentioned concealing her pain, because in her
generation, pain was a sign of emotion, and Bev (G1) suffered with pain for more than
10 years. Bev’s daughter Natalie (G2) said, “I’ve been more proactive about my personal
health because of seeing my mom suffer.” Natalie (G2) explained that when she was
experiencing painful and heavy periods, she made an appointment with a doctor in
town who recommended removing everything. Natalie (G2) responded, “No, I’m not
comfortable with that. What are my other options? ‘Well there’s no other options;
everything’s got to come out,’ the doctor said. Simply, because I am having heavy peri-
ods?” Her daughter Hart (G3) interrupted, “She was sitting in the room with her little
tiny gown and he just comes in and didn’t even introduce himself, didn’t shake her
hand, or say hi.” Natalie (G2) continued:
He said, okay we’re going to have your surgery scheduled for … I said, excuse me.
Random guy I’d never met. And I’m sitting there in a one-size-fits all, and it doesn’t fit all,
like a place mat. And I said, excuse me; we haven’t met. Well, aren’t you Natalie, and blah,
blah … And I stuck my hand out and he turned around. And I thought you’re no
different than, huh-uh, I’m not going to take this. I can hire you and I can fire you. I need
to know who you are and you need to know who I am, and don’t just assume that you’re
going to be pulling all of my female organs out. No. So then he apologized, and he sat
down in front of me. And he started going over my results. And because I was having so
much pain, it turned out that I did have a tumor growing on my one ovary. So that’s why
he said let’s just go ahead and take everything out. I said, no, I want other options. I stood
up and said, you know what, this is my body and I have control over it. I can say yea or
nay. I thought, I’m not going to be like my mom and just lay down and take whatever is
told to me. I have options. And then I sought out a second opinion at another facility.
Hart (G3) then said, “I think society has that mindset, get over it. But I think that
Mom had so much—the doctors would just shoo her away. ‘This is just nonsense.’ ‘It’s
all in your head.’ You know, these headaches that you are having, the nausea, the
cramping … All of this has influenced my sister and I to advocate for ourselves and on
 WOMEN’S REPRODUCTIVE HEALTH 93

her behalf.” The daughters’ and granddaughters’ responses to seeking medical advice
and their desire for participatory dialogue with healthcare providers demonstrate a cul-
tural shift; they are unwilling to comply passively with what they consider to be import-
ant medical decisions regarding their reproductive health.

Discussion
Generational research that privileges women’s lived experiences foregrounds patterns of
knowledge that inform how meanings are socially constructed and acted upon
(Buchanan, Villagran, & Ragan, 2002). Conversations among grandmothers, daughters,
and granddaughters revealed generational differences and similarities in their percep-
tions of how women’s reproductive and sexual health information was and currently is
communicated within various contexts, including media, schools, and the offices of
healthcare providers. Based on the participants’ comments, we conclude that there has
been a cultural shift in how recent generations communicate sexual and reproductive
health concerns to their mothers, teachers, and healthcare providers across the life span.
The grandmothers in our study explained how, in their youth, information about
women’s reproductive and sexual health was inaccessible in mainstream media.
Informed by the silence of their past, some of the grandmothers believe that there is
too much information about reproductive health in mainstream media today, whereas
their daughters were both uncertain and hesitant to make a decisive opinion about
whether media information is “good” or “bad.” Meanwhile, the granddaughters
acknowledged their role as critical consumers of information and, as a result, were skep-
tical about accepting media messages. They felt empowered to seek out information,
especially on the Internet, yet were wary of unsolicited media messages. Young women
in this generation consider source credibility (Sprecher, Harris, & Meyers, 2008), even
as they deal with a culture of media representations that sexualize women and pressure
them starting at young ages to appear “perfect” (Orenstein, 2016; Seibold, 2011). On
one hand, participants’ critical comments about unrealistic portrayals of women in tam-
pon commercials are empowering, and yet, at the same time, limiting. For instance, par-
ticipants who agree to conceal their bodies by avoiding white clothing during
menstruation reinforce a master narrative of menstrual shame (Chrisler, 2011;
Fingerson, 2005; Jackson & Falmagne, 2013). Yet grandmothers and their granddaugh-
ters were quick to construct a counter narrative that holds media representations
accountable for the commoditization of menstruation and feminine hygiene products as
a market for economic growth.
When we examined messages in preparation for menarche at and away from home,
divergent experiences were expressed between what girls are learning at school and how
this information is reinforced at home, which contributed to negotiated narratives.
Because participatory dialogue at school is avoided by teachers, young women are
taught to manage reproductive health on their own, which reinforces dominant socio-
cultural norms about hygiene that lead to the internalization of menstrual shame
(Calogero & Pina, 2011; Diorio & Munro, 2000; Fingerson, 2005; Hasson, 2016; Jackson
& Falmagne, 2013; Johnston-Robledo et al., 2007; Kissling, 2013; Lee, 1994; Martin,
2001; Moore, 1995). Meanwhile, the daughters created counter narratives at home by
94 K. FIELD-SPRINGER ET AL.

introducing the granddaughters to positive books and engaging in conversations to

combat menstrual shame. Contrary to research that has suggested that mothers
reinforce shame at home (Costos, Ackerman, & Paradis, 2002; Lee, 1994), our inter-
views revealed that mothers hoped to create realistic and celebratory counter narratives
about menarche with books that illustrate what to expect in response to the master nar-
ratives to which girls are exposed in school.
Grandmothers, daughters, and granddaughters questioned why it is that mothers talk
to daughters and fathers talk to sons. Sex education in schools not only disappointed
the women in our study, but research has indicated that nearly 50% of boys are eager
to learn more about their own puberty as well as about girls’ reproductive health mile-
stones (Forrest, Strange, Oakley, & Team, 2004). Our participants offered insight that
counters hegemonic cultural and institutionalized norms because they believed that edu-
cating both girls and boys about puberty and reproductive health should start in the
home. Coed conversations about the similarities and differences between girls’ and boys’
reproductive health could engender more positive perceptions of body image and
embodied changes, as well as more empathetic understanding of one another’s develop-
ment of self. If introduced at an earlier age, these empathetic sensibilities might contrib-
ute to the avoidance of disparaging comments by partners toward women experiencing
menopause, such as “Why can’t you control this?,” It’s all in your head,” or “Go to the
doctor” (Dillaway, 2008, p. 47).
Conflicting meanings driven from the use of the word normal by a healthcare pro-
vider to describe menarche and menopause experiences became problematic, even
though participants willingly supported the use of this term in defining their own per-
sonal experiences. For instance, telling them they are normal may alleviate patients’ anx-
iety, fear, and uncertainty; however, what is considered normal for one person may not
be normal for another. Normalization of menarcheal experiences has the potential to
reinforce dominant scripts that pathologize and support biomedical determinants that
lead to the belief that a standardized reproductive health experience exists
(Charlesworth, 2001; Hasson, 2016; Stubbs, 2008). Almost one half of the granddaugh-
ters in our study had requested birth control to suppress acne, consistent with literature
that suggests the pharmaceutical industry is using a postfeminist message agenda to
market reproductive health products (Field-Springer et al., 2018; Hasson, 2016; Kissling,
2013; Repta & Clarke, 2011). Within the context of menopause, normalization of experi-
ences may prevent women from seeking out treatments for other health conditions
(e.g., urinary tract infections) that sometimes affect midlife and older women
(Ghazanfarpour et al., 2017). Our research suggests that, although counter narratives are
employed to resist the imposition of definitions onto one’s lived experience during
reproductive health transitions, master narratives embedded within the messages deliv-
ered from media, teachers, and healthcare providers still control perceptions that limit
the potential for societal transformative change.

Practical implications
Women often call on one another to make sense of shared experiences about reproduct-
ive health. Women also solicit advice from educators and healthcare providers, who
 WOMEN’S REPRODUCTIVE HEALTH 95

communicate the risks and benefits of current treatment options when their patients
need to make personal reproductive health decisions (Theroux, 2010). Our findings
highlight important implications for how mothers, teachers, and healthcare providers
can positively reconstruct messages about sexual and reproductive health milestones.
Mothers have an opportunity to encourage positive perceptions of the reproductive
body prior to menarche, dispel myths about menstruation, and alter the cultural norm
that mothers talk to daughters and fathers talk to sons. The daughters in our study
engaged in realistic and positive discussions with their daughters at home with the aid
of books that celebrate and honor menarche in preparation for this reproductive health
transition. Research has suggested that premenarcheal girls’ attitudes are more positive
than those of postmenarcheal girls; because of this, mothers who want their daughters
to have a positive experience “should [continue to] actively inform their daughters prior
to menarche” (Rembeck et al., 2006, p. 712). Our research also shows that grandmothers
and granddaughters actively deconstructed unrealistic media representations that por-
tray women as one-dimensional and perfect even during menstruation (Douglas, 2010).
One granddaughter shared with us that she cringes at the tagline of a popular tampon
commercial that reads “have a happy period,” which indicates that the menstrual
hygiene industry is selling them products that reinforce sociocultural expectations that
they must conceal their leaking bodies (Erchull, 2013; Young, 2005). Grandmothers and
granddaughters agreed that there is no “perfect period”; however, mothers can continue
this conversation by interrogating unhealthy portrayals of women in media and encour-
aging their daughters to embody menarche by embracing individual, lived experiences
that contribute to the development of a confident and healthy outlook for their body
and sense of self. For instance, mothers can offer health messages that not only inform
but also encourage their daughters to embrace embodied changes to create a sense of
agency that celebrates their identities as healthy girls who will become strong women.
Furthermore, young women are frustrated by the double standard (i.e., teachers who
send positive messages to boys and negative messages to girls about puberty and sexual-
ity) in health education classes in schools today (Diorio & Munro, 2000; Haste, 2013),
and they think that boys fail to display any empathy or understanding of girls’ repro-
ductive health concerns. The women in our study suggested that, if mothers talk to
their sons, this could lead to a cultural shift such that more empathy and understanding
about puberty and reproductive health changes will occur within the next generation.
Sex education and reproductive health are political, which makes them difficult for
teachers to talk about in the classroom (Diorio, 1985; Diorio & Munro, 2000; Strong,
1972). Participants in our study suggested that it does not have to be this way.
According to Forrest et al. (2004), 64% of girls want to learn more about reproductive
health prior to menarche. Yet when the topic of reproductive health was introduced in
the classroom, lessons were impersonal (Lesta, Lazarus, & Ess
en, 2008; Selwyn &
Powell, 2007). Diorio and Munro (2000) suggested that this impersonal approach could
actually do more harm than good by perpetuating a dominant narrative of hygiene con-
trol and ignoring discussions about positive aspects of a girl’s changing body.
Furthermore, when educators espouse the exclusive use of medical, objective terms to
teach reproductive health (e.g., with a focus on sexuality and fertility), girls become the
target of negative messages, including the legitimization of normative beliefs that it is
96 K. FIELD-SPRINGER ET AL.

their responsibility to avoid teenage pregnancy (Charlesworth, 2001; Diorio & Munro,
2000; Johnston-Robledo & Stubbs, 2013; Stubbs, 2008). Teachers who incorporate cele-
bratory narratives into their classroom curriculum honor, as opposed to stigmatize,
menarche, as mothers are attempting to do at home, which could challenge gendered
reproductive health ideologies.
Women in our study emboldened each other to become more involved during
patient–provider interactions, and they were passionate in their desire to know if their
experiences of sexual and reproductive health were normal. Healthcare providers have
an opportunity to alleviate uncertainty, and yet they also need to avoid dominant scripts
that normalize aspects of sexual and reproductive health (Charlesworth, 2001; Hasson,
2016; Stubbs, 2008). For example, patient–provider discussions inclusive of granddaugh-
ters’, daughters’, and grandmothers’ health history afford an opportunity to discuss
evidence-based findings regarding reproductive health, such as the median age at
menarche occurs between 12 and 13 years old, what to expect for a typical cycle length,
and the average amount of bleeding for those who reside in developed countries
(ACOG, 2015). Our participants of recent generations said that they desired participa-
tory dialogue during healthcare encounters in an effort to promote patient empower-
ment as opposed to silently acquiescing to healthcare providers’ orders, an inherit
characteristic of earlier generations. Specifically, the daughters in our study were
more informed about hormone therapy, and, as a result, they questioned the advice of
healthcare providers who wanted to prescribe medications to treat symptoms of peri-
menopause without discussion of alternative holistic approaches. The negative effects of
self-surveillance, body shame, and objectification that can damage girls’ and women’s
development of self during reproductive health milestones was likewise found in our
study. As such, healthcare providers have an opportunity to affect intergenerational
positive images of body and self and to present current evidence on reproductive health
function predicated on the presenting concerns of their patients.

Limitations and future research

The participants in the present study comprised a homogeneous demographic of women
who identified primarily as White and had either earned or were in pursuit of higher
education. Thus our research offers partial perspectives from individuals who are from
relatively privileged backgrounds. Future researchers should work toward answering
Hennegan’s (2017) call concerning obstacles girls encounter in managing menarche in
under-resourced areas, as well as concerns of low-income women who are transitioning
through menopause. For instance, girls in developing countries and rural areas struggle
to manage menstruation, and this affects their education and health. Studies of women’s
reproductive health that focused on underrepresented populations have pointed to
sociocultural differences that could enhance the scope of future studies (see, for
example, Cooper & Koch, 2007; Cornelius, LeGrand, & Jemmott, 2008; Harris, 2013;
Tucker, 1989).
Sex education historically has been communicated to adolescents in the context of a
public health concern (e.g., STIs, teenage pregnancy), and these accounts most often
involve the use of fear driven by political, moral, and social threats of unwelcome
 WOMEN’S REPRODUCTIVE HEALTH 97

outcomes of “irresponsible” sexual behavior (Diorio, 1985; Diorio & Munro, 2000;
Strong, 1972). Women in our study were dissatisfied with education’s role in teaching
preventive care to maintain reproductive and sexual health, which is one of the Centers
for Disease Control and Prevention’s 16 critical components of sex education (Demissie
et al., 2015). More research is needed on how educators can impart information that
avoids fear, shame, or self-objectification (Chang et al., 2010; Jackson & Falmagne,
2013), the development of low self-confidence (Lee, 1994), and myths passed down
from generations over the years (Field-Springer et al., 2018).
Our research was also limited by the perspectives and conversations among three
generations of women who shared their own personal lived experiences about repro-
ductive health with one another. Although study of a small sample of participants
allows for a richness of depth and detail, it also limits the breadth of the findings. Thus
there is a need for more conversational data from a broader, more diverse sample of
participants. Further research in the health sciences is needed to test care delivery mod-
els that exemplify healthy communication trajectories between grandmothers, daughters,
and granddaughters premised on accurate medical information. Studies in these areas
may reveal important information that parents, educators, and healthcare providers can
use to create supportive environments because they will have a better understanding of
gendered, intergenerational communication about reproductive health.

Acknowledgments
Authors would like to acknowledge the work of Nicole Lea Gilmer as a research assistant.

Funding
Research reported in this study was funded by the Dwight Schar College of Nursing and
Health Sciences.

Disclosure statement
The authors have no conflicts of interest to declare.

References
American College of Obstetricians and Gynecologists. (2015). Menstruation in girls and adoles-
cents using the menstrual cycle as a vital sign. Retrieved from https://www.acog.org/Clinical-
Guidance-and-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/
Menstruation-in-Girls-and-Adolescents-Using-the-Menstrual-Cycle-as-a-Vital-Sign
American College of Obstetricians and Gynecologists. (2015). Your first gynecologists visit.
Retrieved from https://www.acog.org/Patients/FAQs/Your-First-Gynecologic-Visit-Especially-
for-Teens.
Buchanan, M. C., Villagran, M. M., & Ragan, S. L. (2002). Women, menopause, and (Ms.) infor-
mation: Communication about the climacteric. Health Communication, 14(1), 99–119.
Calogero, R. M., & Pina, A. (2011). Body guilt: Preliminary evidence for a further subjective
experience of self-objectification. Psychology of Women Quarterly, 35(3), 428–440.
98 K. FIELD-SPRINGER ET AL.

Chang, Y. T., Hayter, M., & Wu, S. C. (2010). A systematic review and meta-ethnography of the
qualitative literature: Experiences of the menarche. Journal of Clinical Nursing, 19(3–4),
447–460.
Chao, C., Slezak, J. M., Coleman, K. J., & Jacobsen, S. J. (2009). Papanicolaou screening behavior
in mothers and human papillomavirus vaccine uptake in adolescent girls. American Journal of
Public Health, 99(6), 1137–1142.
Charlesworth, D. (2001). Paradoxical constructions of self: Educating young women about men-
struation. Women and Language, 24, 13–20.
Charmaz, K. (2014). Constructing grounded theory. Thousand Oaks, CA: Sage.
Chrisler, J. C. (2011). Leaks, lumps, and lines: Stigma and women’s bodies. Psychology of Women
Quarterly, 35(2), 202–214.
Cimons, M. (2006). Menopause: Milestone or misery? A look at media messages to our mothers
and grandmothers. American Journalism, 23(1), 63–94.
Cooper, S. C., & Koch, P. B. (2007). “Nobody told me nothin”: Communication about menstru-
ation among low-income African American women. Women & Health, 46(1), 57–78.
Cornelius, J. B., LeGrand, S., & Jemmott, L. (2008). African American grandparents’ and adoles-
cent grandchildren’s sexuality communication. Journal of Family Nursing, 14 (3), 333–346.
Costos, D., Ackerman, R., & Paradis, L. (2002). Recollections of menarche: Communication
between mothers and daughters regarding menstruation. Sex Roles, 46(1/2), 49–59.
Demissie, Z., Brener, N., McManus, T., Shanklin, S., Hawkins, J., & Kann, L. (2015). School health
profiles 2014: Characteristics of health programs among secondary schools. Atlanta, GA: Centers
for Disease Control and Prevention. Retrieved from https://www.cdc.gov/healthyyouth/data/
profiles/pdf/2014/2014_profiles_report.pdf
Diamant, A. (2010). The red tent-: A novel. New York, NY: St. Martin’s Press.
Dillaway, H. (2007). “Am I similar to my mother?” How women make sense of menopause using
family background. Women & Health, 46, 79–97.
Dillaway, H. E. (2008). “Why can’t you control this?” How women’s interactions with intimate
partners define menopause and family. Journal of Women & Aging, 20, 47–64.
Dillaway, H., & Burton, J. (2011). “Not done yet?!” Women discuss the “end” of menopause.
Women’s Studies, 40(2), 149–176.
Diorio, J. A. (1985). Contraception, copulation domination, and the theoretical barrenness of sex
education literature. Educational Theory, 35(3), 239–254.
Diorio, J. A., & Munro, J. A. (2000). Doing harm in the name of protection: Menstruation as a
topic for sex education. Gender and Education, 12(3), 347–365.
Douglas, S. (2010). Enlightened sexism: The seductive message that feminism’s work is done. New
York, USA: Times Books/Henry Holt and Company.
Ellis, C., & Berger, L. (2002). Their story/my story/our story: Including the researcher’s experi-
ence in interview research. In J. F. Gubrium & J. A. Holstein (Eds.), Handbook of interview
research (pp. 849–876). Thousand Oaks, CA: Sage.
Erchull, M. J. (2013). Distancing through objectification? Depictions of women’s bodies in men-
strual product advertisements. Sex Roles, 68(1–2), 32–40.
Field-Springer, K. (2012). Red, hot, healthy mommas: (Un)conventional understandings of
women, health, and aging. Research on Aging, 34(6), 692–713.
Field-Springer, K., Randall-Griffiths, D., & Reece, C. (2018). From menarche to menopause:
Understanding reproductive health milestones through multigenerational communication.
Health Communication, 33(6), 733–742.
Fingerson, L. (2005). Agency and the body in adolescent menstrual talk. Childhood, 12(1),
91–110.
Forrest, S., Strange, V., Oakley, A., & Team, T. R. (2004). What do young people want from sex
education? The results of a needs assessment from a peer-led sex education programme.
Culture, Health & Sexuality, 6, 337–354.
Ghazanfarpour, M., Khadivzadeh, T., Roudsari, R. L., & Hazavehei, S. M. M. (2017). Obstacles to
the discussion of sexual problems in menopausal women: A qualitative study of healthcare
providers. Journal of Obstetrics and Gynaecology, 37(5), 660–666.
 WOMEN’S REPRODUCTIVE HEALTH 99

Gullette, M. M. (2003). What to do when being aged by culture: Hidden narratives from the
twentieth-century hormone debate. Generations, 27, 71–76.
Guttmacher Institute. (2017). Sex and HIV education. Retrieved from https://www.guttmacher.
org/print/state-policy/explore/sex-and-hiv-education.
Harris, A. L. (2013). “I got caught up in the game”: Generational influences on contraceptive
decision making in African–American women. Journal of the American Association of Nurse
Practitioners, 25(3), 156–165.
Harter, L. M. (2012). Imagining new normals: A narrative framework for health communication.
Dubuque, IA: Kendall Hunt.
Hasson, K. A. (2016). Not a real period: Social and material constructions of menstruation.
Gender & Society, 30, 958–983.
Haste, P. (2013). Sex education and masculinity: The ‘problem’ of boys. Gender and Education,
25(4), 515–527.
Hennegan, J. (2017). Menstrual hygiene management and human rights: The case for an evi-
dence-based approach. Women’s Reproductive Health, 4(3), 212–231.
Hyde, A., Nee, J., Drennan, J., Butler, M., & Howlett, E. (2011). Women’s accounts of heterosex-
ual experiences in the context of menopause. International Journal of Sexual Health, 23(3),
210–223.
Jackson, T. E., & Falmagne, R. J. (2013). Women wearing white: Discourses of menstruation and
the experience of menarche. Feminism & Psychology, 23, 379–398.
Johnston-Robledo, I., Sheffield, K., Voigt, J., & Wilcox-Constantine, J. (2007). Reproductive
shame: Self-objectification and young women’s attitudes toward their reproductive functioning.
Women & Health, 46, 25–39.
Johnston-Robledo, I., & Stubbs, M. L. (2013). Positioning periods: Menstruation in social context.
Sex Roles, 68(1-2), 1–8.
Kalcik, S. (1975). “ … Like Ann’s gynecologist or the time I was almost raped.” Journal of
American Folklore, 88(347), 3–11.
Kissling, E. A. (2013). Pills, periods, and postfeminism: The new politics of marketing birth con-
trol. Feminist Media Studies, 13(3), 490–504.
Lee, J. (1994). Menarche and the (hetero) sexualization of the female body. Gender & Society, 8,
343–362. doi:10.1177/089124394008003004
Lee, J. (2008). “A kotex and a smile”: Mothers and daughters at menarche. Journal of Family
Issues, 29(10), 1325–1347.
Lee, J. (2009). Bodies at menarche: Stories of shame, concealment, and sexual maturation. Sex
Roles, 60(9-10), 615–627.
Lesta, S., Lazarus, J. V., & Ess
en, B. (2008). Young Cypriots on sex education: Sources and
adequacy of information received on sexuality issues. Sex Education, 8(2), 237–246.
Lyotard, J. F. (1984). The postmodern condition: A report on knowledge. [G. Bennington and B.
Massumi (Trans.).] Minneapolis, MN: University of Minnesota Press.
Martin, E. (2001). The woman in the body: A cultural analysis of reproduction. Boston, MA:
Beacon Press.
Marv
an, M. L., & Molina-Abolnik, M. (2012). Mexican adolescents’ experience of menarche and
attitudes toward menstruation: Role of communication between mothers and daughters.
Journal of Pediatric and Adolescent Gynecology, 25(6), 358–363.
Mead, G. H. (1934/1967). Mind, self, and society from the standpoint of a social behaviorist. C.W.
Morris (Ed.). Chicago, IL: University of Chicago Press. (Original work published in 1934).
Miller-Day, M. A. (2004). Communication among grandmothers, mothers, and adult daughters: A
qualitative study of maternal relationships. Mahwah, NJ: Erlbaum.
Moore, S. M. (1995). Girls’ understanding and social constructions of menarche. Journal of
Adolescence, 18(1), 87–104. doi:10.1006/jado.1995.1007
Mosavel, M., Simon, C., & Van Stade, D. (2006). The mother-daughter relationship: What is its
potential as a locus for health promotion? Health Care for Women International, 27(7),
646–664.
100 K. FIELD-SPRINGER ET AL.

Murtagh, M. J., & Hepworth, J. (2005). Narrative review of changing medical and feminist per-
spectives on menopause: From femininity and ageing to risk and choice. Psychology, Health &
Medicine, 10, 276–290.
Nelson, H. L. (2001). Damaged identities, narrative repair. Ithaca, NY: Cornell University Press.
Nelson, H. D., Taylor, B., & Weatherall, I. (2008). Menopause. Lancet (London, England),
371(9614), 760–770.
Obono, K. (2012). Patterns of mother-daughter communication for reproductive health know-
ledge transfer in Southern Nigeria. Global Media Journal, 5, 95–110.
Orenstein, P. (2016). Girls & sex: Navigating the complicated new landscape. New York, USA:
HarperCollins.
Pennebaker, J. W. (2000). Telling stories: The health benefits of narrative. Literature and
Medicine, 19(1), 3–18.
Porter, M. (2006). Accomplishing transitions: Learning about sex in Newfoundland and
Labrador. Pakistan Journal of Women’s Studies, 13, 1024–1256.
Porter, M., & Gustafson, D. L. (2012). Reproducing women: Family and health work across three
generations. Black Point, Nova Scotia: Fernwood Publishing.
Rembeck, G. I., M€ oller, M., & Gunnarsson, R. K. (2006). Attitudes and feelings towards menstru-
ation and womanhood in girls at menarche. Acta Paediatrica, 95(6), 707–714.
Repta, R., & Clarke, L. H. (2011). “Am I going to be natural or not?” Canadian women’s percep-
tions and experiences of menstrual suppression. Sex Roles, 68(1-2), 91–106.
Roberts, M. E., Gerrard, M., Reimer, R., & Gibbons, F. X. (2010). Mother-daughter communica-
tion and human papillomavirus vaccine uptake by college students. Pediatrics, 125(5), 982–989.
Rubinstein, H. R., & Foster, J. L. (2013). “I don’t know whether it is to do with age or to do with
hormones and whether it is do with a stage in your life”: Making sense of menopause and the
body. Journal of Health Psychology, 18(2), 292–307.
Schaefer, V. L. (1998). The care & keeping of you: The body book for girls. American Girl.
Scott, J. W. (1991). The evidence of experience. Critical Inquiry, 17(4), 773–797. doi:10.1086/
448612
Selwyn, N., & Powell, E. (2007). Sex and relationships education in schools: The views and expe-
riences of young people. Health Education, 107(2), 219–231.
Shore, G. (1999). Soldiering on: An exploration into women’s perceptions and experiences of
menopause. Feminism & Psychology, 9, 168–178.
Siebold, C. (2011). Factors influencing young women’s sexual and reproductive health.
Contemporary Nurse, 37(2), 124–136.
Sprecher, S., Harris, G., & Meyers, A. (2008). Perceptions of sources of sex education and targets
of sex communication: Sociodemographic and cohort effects. Journal of Sex Research, 45(1),
17–26.
Strong, B. (1972). Ideas of the early sex education movement in America, 1890–1920. History of
Education Quarterly, 12(2), 129–161.
Stubbs, M. L. (2008). Cultural perceptions and practices around menarche and adolescent men-
struation in the United States. Annals of the New York Academy of Sciences, 1135(1), 58–66.
doi:10.1196/annals.1429.008
Sveinsd
ottir, H. (2017). The role of menstruation in women’s objectification: A questionnaire
study. Journal of Advanced Nursing, 73(6), 1390–1402.
Taghva, N. (2010). The effect of group training for mothers on the attitudes of pre-adolescent
daughters towards bio-psycho-social changes. Procedia - Social and Behavioral Sciences, 5,
1540–1544. doi:10.1016/j.sbspro.2010.07.322
Teitelman, A. M. (2004). Adolescent girls’ perspectives of family interactions related to menarche
and sexual health. Qualitative Health Research, 14(9), 1292–1308. doi:10.1177/
1049732304268794
Theroux, R. (2010). Women’s decision making during the menopausal transition. Journal of the
Academy of Nurse Practitioners, 22(11), 612–621.
 WOMEN’S REPRODUCTIVE HEALTH 101

Torres, L. (1992). Women’s narratives in a New York Puerto Rican community. In L. F. Rakow
(Ed.), Women making meaning: New feminist directions in communication (pp. 244–262). New
York, USA: Routledge.
Tucker, S. K. (1989). Adolescent patterns of communication about sexually related topics.
Adolescence, 24, 269–278.
Utz, R. L. (2011). Like mother, (not) like daughter: The social construction of menopause and
aging. Journal of Aging Studies, 25(2), 143–154.
Warren-Jeanpiere, L., Miller, K. S., & Warren, A. M. (2010). African American women’s retro-
spective perceptions of the intergenerational transfer of gynecological health care information
received from mothers: Implications for families and providers. Journal of Family
Communication, 10(2), 81–98.
Washington, P. K., Burke, N. J., Joseph, G., Guerra, C., & Pasick, R. J. (2009). Adult daughters’
influence on mothers’ health-related decision making: An expansion of the subjective norms
construct. Health Education & Behavior, 36, 129S–144S. doi:10.1177/1090198109338904
Young, I. M. (2005). On female body experience: “Throwing like a girl” and other essays. New
York, USA: Oxford University Press.