Adolescent girls in the European Region: highlights from a literature review

Mental health

• Existing research shows a distinct gender pattern in mental health after the age of 13; different problems afflict boys and girls, with girls generally reporting more mental health problems than boys. Depressive symptoms and anxiety are twice as common among girls as boys, with teenage boys score higher on self-esteem scales than do girls.
• Public health and socio-cultural health research has found that girls’ and boys’ different experiences and exposures in terms of stress, violence, cultural norms, workload and increased strain may contribute to the elevated levels of mental health problems observed among girls.
• Evidence of decreasing gender differences in depression and substance use has been found largely in countries where the roles of women have improved in terms of opportunities for employment, access to birth control and other indicators of increasing gender role equality; trend studies in countries where gender roles have remained static or changes over periods of historical time have been minor have not documented a reduction in gender differences in depression or substance use.

Violence prevention and management

• Girls face greater risks of sexual violence, neglect and forced prostitution. WHO estimates that 150 million girls under 18 have experienced forced sexual intercourse or other forms of sexual violence, with most of the abuse occurring within the family circle.
• It is estimated that 82 million girls marry before age 18, while a significant number are married at even younger ages, frequently under coercion, facing a high risk of violence, including forced sex.
• The need to increase investment in prevention is urgent and global. Promising strategies include: reducing unintended pregnancies; improving access to high-quality pre- and post-natal care; reducing harmful levels of alcohol and illicit drug use during pregnancy and by new parents; providing home visitation services by nurses and social workers to families at risk of maltreatment; and training parents on child development, non-violent discipline and problem-solving skills.

Sexual and reproductive health

• Many studies have identified risk factors leading to early sexual initiation (poor family relationships, peer pressure, low education and socio-economic status).  Key positive aspects of an adolescent’s social environment, such as a caring family relationship and a good school environment, have shown to act as a protection against unsafe sexual behaviour.
• Studies show adolescent girls commonly face obstacles when seeking medical contraceptive advice, with insufficient knowledge regarding modern methods, limited access to services, and healthcare providers who actively discourage use of contraception by teenagers.
• Adolescent sexual behaviour has become increasingly risky over the latter decades.  Greater proportions of females than males feel pressure during their first sexual intercourse, regret that it took place and do not enjoy later sex encounters.
• Teenage girls are often influenced, directly or indirectly, by the attitudes of their partners, family and friends or by social norms, as well as to the extent to which the decision for abortion truly belongs to the woman.  The main reasons for unplanned pregnancies are underestimation of pregnancy risk and inconsistent contraceptive use.
• It is more common for boys to have casual relationships or "one-nightstands" and multiple sex partners.  Alcohol is considered one of the most common reasons for increased sexual risk taking. Gender roles could partly explain these differences.

Prevention and management of HIV/AIDS and STIs

• Many factors contribute to the risk of contracting STIs, HIV or negative health outcomes of early pregnancy, with some subgroups being especially vulnerable. Biologically, the immature reproductive and immune systems of adolescent girls translate to increased susceptibility to STIs and HIV transmission.
• Within a society, there may be widely differing beliefs, expectations, customs and practices that define ‘masculine’ and ‘feminine’ attributes, behaviour, roles and responsibilities. Gender is an integral factor in determining an individual’s vulnerability to HIV infection, his or her ability to access care, support or treatment, as well as the ability to cope when infected or affected by HIV.
• Gender norms in some societies often dictate that women and girls should be ignorant and passive about sex, unable to insist on safer sex and without access to appropriate health services. Many societies also reinforce a belief that men should seek multiple sexual partners, take risks and be self-reliant, in detriment of prevention messages that support fidelity and other protective measures against HIV.  Some notions of masculinity also condone violence against women, which has a direct link to increasing HIV vulnerability.

Injuries and substance abuse

• Heavy episodic drinking among girls in many European countries has increased considerably. Alcohol usually has a higher effect on young girls who tend to have higher concentrations of alcohol in their blood than young boys, given an identical alcohol intake.
• Changing gender norms, such as greater female autonomy and changes in women’s roles may put girls at risk from smoking or alcohol. Inducement to smoke is strongly backed by targeted marketing of cigarette companies, showing smoking as both emancipation and a stress coping strategy for women; this gender shift is most notable among the young.
• Studies show that young girls are more likely to fear weight gain than boys, and may start smoking for weight control.
• The few existing evidence based studies on successful gender-sensitive programmes for preventing substance abuse among girls and boys suggest that the most effective programs for girls are family focused, targeting family bonding, supervision and communication.

Overweight and obesity

• A study carried out in France investigating the relation between early life conditions and adult obesity found that no salient factor emerged in men. In women, however, after controlling for current socio-demographic characteristics, a relation was found between obesity and the following factors: father’s occupation (higher risk for women whose father did clerical work, versus those whose father occupied a higher-level position); experience of economic hardship in childhood; and high parity (for parities over three versus parity of 1).
• Studies also show that there is a stronger social gradient for women, indicating that a high relative body weight was associated with women’s less favourable social and material conditions; this same did not affect men.

Social and emotional health

• Diverse cross-cultural studies have found a significantly higher prevalence of externalized behavioual problems in boys, whereas girls present more anxious–depressive or internalized problems.
• The studies that have explored gender differences in conflict-solving styles have found that girls score higher in communication skills when dealing with conflict, are more precise in the perception of conflict, have greater empathy skills, whereas boys are more assertive with regard to their needs.
• Bonding with parents plays a central role in the development of a female adolescent; empirical studies show that girls’ relationships with parents are characterized by greater intimacy and reciprocity than boys’. In girls, secrets kept from parents can be considered as a marker of a poor relationship quality in early years but also as a predictor of poor relationships with parents in the future. Moreover, girls are found to be more dependent on the parent–child relationship and need higher levels of emotional support from their caregivers.
• There is evidence of gender differences with respect to adolescent self-esteem and parenting styles. Males scored higher on standard measures of global self-esteem than females. Further, authoritarian parenting, which has been linked to low self-esteem, shows a greater impact in the development of female personalities than that of males.

The full literature review will be available shortly.