The health risks of maturing early

I remember the first time a stranger openly gawked at my bare legs. It was the summer before I turned 11; I was at a small convenience store near our home. The man stood behind my mother and me at the checkout line, staring me up and down. He looked the same age as my father. But it wasn’t friendliness I detected in his eyes.

As a young girl who developed early and looked older than my age, my mind struggled to catch up with the rapid changes taking place in my body. The stares from older men made me feel anxious and unsafe. Every time a stranger made kissing sounds as I walked by, my heart pounded and my mouth turned dry. If I close my eyes, I can still hear their voices yelling obscenities from passing vehicles; I am once again a 10-year-old child afraid of wearing shorts in public.

Enduring unwanted comments and stares may seem minor compared to other types of sexual violence. Still, studies have shown they can be particularly distressing for a child, putting them at risk of psychological problems that can reverberate throughout their life.

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Movements like #MeToo have emphasised the frequency of sexual harassment in the workplace. But sexual harassment of minors remains a less common topic of discussion – though it’s one that may have increasing urgency, as puberty seems to be coming earlier for increasing numbers of girls across the globe. While the average age of puberty onset, defined by breast development, for US girls was almost 12 years old in the 1970s, it fell to nine years by 2011. One study found that 18% of white, 43% of black non-Hispanic and 31% of Hispanic girls hit puberty by their ninth birthday. Researchers are still analysing the reasons.

This places children as young as six to eight years old at greater risk for sexual harassment. Girls who reach puberty earlier are sexually harassed more than their peers, regardless of whether they’re engaging in sexual behaviours earlier – one reason researchers had thought they might have been targeted. And the attention comes from their peers as well as adults. Both boys and girls who develop early are more likely to be sexually harassed by their classmates.

In the UK, one recent BBC investigation found that children as young as six years old have been sexually assaulted on trains or in train stations.

Carrie Juergens, a 26-year-old Oregon resident, still remembers when she visited a water park with her family when she was 11. A grown man followed her into one of the nearby hot tubs and positioned his arms on the space behind her. He asked what school she went to and how old she was. “I ran to a different part of the water park, and he followed me and tried to tickle me,” she says. “I didn't know how to respond because society trains girls to be nice.”

Juergens says she remembers thinking: “if this is what being a woman means, I want no part of it.”

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Although puberty presents challenges for all adolescents, girls who mature ahead of their peers are particularly vulnerable. One recent study, which tracked more than 7,000 women over a period of 14 years, found that early menarche (the first menstrual bleeding) was associated with elevated rates of depression, substance abuse, eating disorders, and anti-social behaviours in adulthood. “The effects of early puberty on psychological health have been replicated in many different countries around the world,” says Jane Mendle, the study’s co-author and a psychology professor at Cornell University.

One reason may be that early-maturing girls experience a spike in unwanted attention and comments about their bodies from older boys and grown men. “The important thing about puberty is that it’s visible to others,” Mendle points out.

But a young girl with breasts is no less of a child, or better able to handle such a situation, than one who hasn’t yet developed. Indeed, at age 10, my repertoire of favourite activities still included playing with Barbies and watching the Disney Channel with my younger brother. Emotionally, I was unprepared to grasp the nature of men’s attention.

Sexualisation of girls is especially problematic in cultures where puberty automatically tags a girl as ready for marriage. Today, the children’s charity Unicef estimates that worldwide, one in three women (about 250 million) were wed before the age of 15. This isn’t limited to developing countries. Most US states allow minors to marry in particular circumstances, for example, including at 13 years old or younger. Unchained at a Glance, a nonprofit dedicated to helping women and girls in the US escape forced marriages, has estimated that 248,000 children as young as 12 were married in the US between 2000-2010.

The consequences of early marriage are long-lasting, often affecting a girl’s ability to get an education and posing severe health repercussions. In many rural areas of Bangladesh, for example, girls are married off just after they experience their first menstrual flow. When these girls become pregnant, they have a 1 in 110 chance of dying in childbirth – five times higher than mothers aged 20 to 24 – making such deaths “unacceptably common”. And while more research is needed on the mental health effects associated with childhood marriage, one study from Ethiopia found a correlation between being wedded young and increased risk of suicide in girls as young as 10.

Part of the problem is that when a girl first starts showing signs of puberty, even long before her first period, some families fear that a girl will engage in a sexual relationship or be assaulted. Marriage, therefore, can be seen as a way to ‘protect’ her.

“This fear amidst parents and communities creates an environment where as girls get older, their worlds get smaller, with more and more restrictions placed on their mobility,” says Nidal Karim, a gender specialist at international nonprofit Care who focuses on Nepal and Bangladesh, two countries where these issues are especially acute.

“Girls’ sexuality is the concern of others,” Karim adds. “But girls themselves are seldom given any information about their own bodies, puberty, sex, and reproduction in order to prepare and protect themselves.”

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Even in countries where child marriage is less common, early puberty can be problematic.

For Pauline Campos, a Minnesota-based freelance writer, receiving unwanted sexual attention as a child made her feel uncomfortable in her own skin. By age 8, she recalls wearing a B-cup and trying to hide beneath baggy shirts and oversized tunics. “I felt very weird inside of me because my brain during that age didn't match my body,” she says.

Now, as an adult, Campos attributes these experiences to her subsequent body dysmorphia. “I've called myself a lifelong recovering bulimic, because even though I haven't binged and purged in a really long time, the mindset – once it starts it doesn't go away,” she says. “There always comes a certain point where I'm getting healthier for myself and I start feeling self-conscious about the curves that I see defined in the mirror.”

In fact, studies have shown that experiencing sexual harassment in early puberty contributes to objectified body consciousness (OBC): a term psychologists use to describe the tendency to view one’s body as an object to be looked at and evaluated.

A growing body of research supports how damaging early sexual objectification can be. One 2016 study suggests that sexual harassment is associated with increased levels of depressive symptoms and negative body image – so it may be no surprise that girls between the ages of 11 and 13 report higher levels of self-objectification, body shame, rumination, and depression than boys. They are also more likely to feel embarrassed, anxious, and have suicidal thoughts.

Girls who develop early also face a host of other issues like disordered eating, delinquency and lower academic achievement than their peers.

Entering into an adult world of sexual appraisal causes girls to feel assessed, judged, and visible in new ways, says Celia Roberts, a sociologist and professor of gender and science studies at Lancaster University. “This a big change from being a child, where you tend to assume – unless you have been mistreated – that you are valuable and important in your own right as a human being,” she says. Sexual harassment “makes you feel that you are an object for others’ use or domination rather than your own person”.

Even in supposed ‘safe zones’ like schools, girls are often the targets of sexual harassment and rumours. One national US survey found that 56% of female adolescents, along with 40% of boys, reported being sexually harassed. And it starts young. By the sixth grade – when children are usually aged about 11 or 12 – over a third of female students have been sexually harassed by a boy.

Mendle says that other kids may be curious or awkward when they see changes in girls’ bodies – but they can also be malicious.

This can be particularly difficult to go through during early puberty, when children are still discovering how they want to express their identity. And for girls who may never choose to adopt a feminine persona, these assumptions about their ‘womanly’ traits can be especially damaging. Meanwhile, gender-nonconforming students are at even more risk for sexual harassment than their peers: one study found that 81% of transgender youth and 72% of lesbian girls have been sexually harassed, compared to 43% of heterosexual cisgender girls and 23% of heterosexual cisgender boys.

For girls of colour, who often experience both racialised and fetishised comments, harassment can also be more severe.

One Asian-American psychologist in California, who asked for anonymity because she was concerned about her patients learning about her personal life, recalls receiving nasty comments about her body by the time she was 12. “One of my earliest memories was this boy in my class who pretty much just said that he was going to have sex with me,” she says. She recalls that these comments were often accompanied by racist remarks like “‘Do you have a lot of pubic hair? Because I've heard that Asians don't have a lot of pubic hair.’”

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Despite the negative mental health outcomes associated with early-maturing girls, Therese Skoog, a psychology professor at the University of Gothenburg, has found they can also appear to be more psychologically mature and well-adjusted.

For myself, I have found that going through these experiences at such a young age has led to greater empathy and emotional acuity in adulthood, particularly with those who share similar experiences.

Researchers agree that it’s important not to catastrophise about early sexual development in and of itself. The problem isn’t that a girl’s body is changing. It’s society’s response to it. As a result, they say we should think about how we might support girls and their families best, and as Roberts puts it, “contest the sexist cultures that may turn puberty into a disturbing experience”.

Skoog believes the answer lies in the development of social and emotional learning programmes that teach core sexual education principles and concepts like social awareness, empathic ability, and impulse control. This could be a part of future intervention efforts, and used for policy aimed at reducing the risk of sexual harassment for all adolescents, including early-maturing girls.

We need to “increase socially respectful behaviour and the understanding that neither a sexual appearance nor sexual activities mean that girls or women are positive [about] or open to any kind of sexual advances.”

Only by creating an environment of zero tolerance can we make a stand against the pervasiveness of sexual harassment – including when it affects children.

Correction: An earlier version of this story stated that, according to one study, 40% of girls now reach puberty before the age of nine; the 40% figure referred specifically to black non-Hispanic girls in the US. This has been fixed.

This story is part of the Health Gap, a special series about how men and women experience the medical system – and their own health – in starkly different ways.